Provider Demographics
NPI:1982089769
Name:WILLARD, COLLETTE (LMSW)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5050
Mailing Address - Country:US
Mailing Address - Phone:860-346-0771
Mailing Address - Fax:860-346-0772
Practice Address - Street 1:1251 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5050
Practice Address - Country:US
Practice Address - Phone:860-346-0771
Practice Address - Fax:860-346-0772
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1931OtherLMSW