Provider Demographics
NPI:1831566983
Name:CESCA, GARY (LCSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:CESCA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREEN HILL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4416
Mailing Address - Country:US
Mailing Address - Phone:860-803-0361
Mailing Address - Fax:
Practice Address - Street 1:45 NORTH SCHOOL ST
Practice Address - Street 2:MANCHESTER PUBLIC SCHOOLS
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-647-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063031041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool