Provider Demographics
NPI:1023522406
Name:PANEVA, RADMILA (LCSW/LICSW)
Entity type:Individual
Prefix:
First Name:RADMILA
Middle Name:
Last Name:PANEVA
Suffix:
Gender:F
Credentials:LCSW/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 SILAS DEANE HIGHWAY
Mailing Address - Street 2:STE 40
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2333
Mailing Address - Country:US
Mailing Address - Phone:860-812-4333
Mailing Address - Fax:
Practice Address - Street 1:2264 SILAS DEANE HWY STE 40
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2333
Practice Address - Country:US
Practice Address - Phone:860-812-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084051041C0700X
CT68311285441041S0200X
RIISW036351041C0700X
PACW0238291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool