Provider Demographics
NPI:1831470210
Name:MARTWINSKI-NARDOZZI, STACEY L (MSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:MARTWINSKI-NARDOZZI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUL FRIENDS 300 CHURCH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2253
Mailing Address - Country:US
Mailing Address - Phone:203-679-0849
Mailing Address - Fax:203-679-0348
Practice Address - Street 1:SOUL FRIENDS 300 CHURCH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2253
Practice Address - Country:US
Practice Address - Phone:203-679-0849
Practice Address - Fax:203-679-0348
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical