Provider Demographics
NPI:1881739183
Name:FAWCETT, NANCY ALINE (MSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ALINE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HEAD OF MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1788
Mailing Address - Country:US
Mailing Address - Phone:203-426-1402
Mailing Address - Fax:
Practice Address - Street 1:2 OLMSTEAD PL
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1318
Practice Address - Country:US
Practice Address - Phone:203-426-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical