Provider Demographics
NPI:1518050434
Name:EWING, CATHERINE MARIE (LCSW, MDIV)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
Last Name:EWING
Suffix:
Gender:F
Credentials:LCSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9A PASCO DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-1700
Mailing Address - Country:US
Mailing Address - Phone:860-899-1220
Mailing Address - Fax:860-838-6460
Practice Address - Street 1:9A PASCO DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-1700
Practice Address - Country:US
Practice Address - Phone:860-899-1220
Practice Address - Fax:860-838-6460
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0019691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT001969OtherSOCIAL WORK LICENSE
CT800003713Medicare ID - Type Unspecified