Provider Demographics
NPI:1144876723
Name:GAGLIARDI, JEFFREY (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOVER CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2849
Mailing Address - Country:US
Mailing Address - Phone:203-379-8400
Mailing Address - Fax:
Practice Address - Street 1:5 DOVER CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2849
Practice Address - Country:US
Practice Address - Phone:203-379-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0914161041C0700X
CT106941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical