1851530463 NPI number — JILLIAN L ADELSBERG LCSW

Table of content: JILLIAN L ADELSBERG LCSW (NPI 1851530463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851530463 NPI number — JILLIAN L ADELSBERG LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADELSBERG
Provider First Name:
JILLIAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALANDRUCCIO
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851530463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MOTT AVE FL 4
Provider Second Line Business Mailing Address:
FAMILY & CHILDRENS AGENCY
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06850-3330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-855-8765
Provider Business Mailing Address Fax Number:
203-838-3325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MOTT AVE FL 4
Provider Second Line Business Practice Location Address:
FAMILY & CHILDRENS AGENCY
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06850-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-855-8765
Provider Business Practice Location Address Fax Number:
203-838-3325
Provider Enumeration Date:
02/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  006324 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)