Provider Demographics
NPI:1902972649
Name:LLOYD, TANGLEY CANPBELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANGLEY
Middle Name:CANPBELL
Last Name:LLOYD
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 1:132 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2744
Mailing Address - Country:US
Mailing Address - Phone:203-918-7877
Mailing Address - Fax:203-862-9501
Practice Address - Street 1:132 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807
Practice Address - Country:US
Practice Address - Phone:203-918-7877
Practice Address - Fax:203-862-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004172912Medicaid
CT004172920Medicaid
CT800003193Medicare ID - Type Unspecified