Provider Demographics
NPI:1871029728
Name:AGUILAR, JEMEL (MSW, PHD)
Entity Type:Individual
Prefix:
First Name:JEMEL
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CORTLAND WAY
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5331
Mailing Address - Country:US
Mailing Address - Phone:860-937-8541
Mailing Address - Fax:
Practice Address - Street 1:31 CORTLAND WAY
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-5331
Practice Address - Country:US
Practice Address - Phone:860-937-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT98081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical