Provider Demographics
NPI:1740999598
Name:POWELL, VIRNA R (LCSW)
Entity type:Individual
Prefix:
First Name:VIRNA
Middle Name:R
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VIRNA
Other - Middle Name:R
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:89 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1688
Mailing Address - Country:US
Mailing Address - Phone:860-830-1832
Mailing Address - Fax:
Practice Address - Street 1:1209 JOHN FITCH BLVD UNIT 2A
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2483
Practice Address - Country:US
Practice Address - Phone:860-830-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT126021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical