Provider Demographics
NPI:1912098492
Name:PAGE, ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:419 WHALLEY AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3019
Mailing Address - Country:US
Mailing Address - Phone:203-785-1331
Mailing Address - Fax:203-848-1466
Practice Address - Street 1:660 WINCHESTER AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1969
Practice Address - Country:US
Practice Address - Phone:203-776-8390
Practice Address - Fax:203-773-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0019521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ50001Medicare UPIN
CT800003686Medicare PIN
CT800003983Medicare PIN