Provider Demographics
NPI:1841348562
Name:WALL, RONA B (LCSW)
Entity type:Individual
Prefix:
First Name:RONA
Middle Name:B
Last Name:WALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WOODSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2322
Mailing Address - Country:US
Mailing Address - Phone:203-557-8353
Mailing Address - Fax:
Practice Address - Street 1:100 ELIZABETH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1819
Practice Address - Country:US
Practice Address - Phone:203-446-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO45247001041C0700X
CT85691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ679770Medicare ID - Type Unspecified