Provider Demographics
NPI:1669102992
Name:GELMAN-WEGENER, LIANE CYNTHIA
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:CYNTHIA
Last Name:GELMAN-WEGENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BLANCHARD RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1933
Mailing Address - Country:US
Mailing Address - Phone:203-520-0344
Mailing Address - Fax:
Practice Address - Street 1:78 TRIANGLE ST # I-4
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6977
Practice Address - Country:US
Practice Address - Phone:203-448-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical