Provider Demographics
NPI:1669872743
Name:SUNDEL, CARLY (LCSW)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SUNDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:SUNDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107G FENN RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2250
Mailing Address - Country:US
Mailing Address - Phone:860-580-9883
Mailing Address - Fax:
Practice Address - Street 1:1177 SILAS DEANE HWY STE 3
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4332
Practice Address - Country:US
Practice Address - Phone:860-837-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102271041C0700X
104100000X
CT102271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker