Provider Demographics
NPI:1932130028
Name:TATROE, SANDRA BALTAZAR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BALTAZAR
Last Name:TATROE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:CHAVES
Other - Last Name:BALTAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:81 REGINA ST
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3021
Mailing Address - Country:US
Mailing Address - Phone:203-258-1876
Mailing Address - Fax:203-503-3284
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3250
Practice Address - Fax:203-503-3254
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005672104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid