Provider Demographics
NPI:1255610267
Name:HALL, CAROLINE (ACSW,MSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:ACSW,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GLASTONBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4402
Mailing Address - Country:US
Mailing Address - Phone:860-659-9382
Mailing Address - Fax:860-633-4545
Practice Address - Street 1:140 GLASTONBURY BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4402
Practice Address - Country:US
Practice Address - Phone:860-659-9382
Practice Address - Fax:860-633-4545
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2015-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical