Provider Demographics
NPI:1720143951
Name:LIZCANO, HECTOR G (LCSW LADC)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:G
Last Name:LIZCANO
Suffix:
Gender:M
Credentials:LCSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4517
Mailing Address - Country:US
Mailing Address - Phone:203-494-0333
Mailing Address - Fax:203-974-5850
Practice Address - Street 1:904 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3921
Practice Address - Country:US
Practice Address - Phone:203-624-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLADC 000190101YA0400X
CTLCSW0038611041C0700X
CT0038611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)