Provider Demographics
NPI:1538437470
Name:NGUYEN, LOAN THI (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOAN
Middle Name:THI
Last Name:NGUYEN
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 1:351 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3919
Mailing Address - Country:US
Mailing Address - Phone:860-262-5345
Mailing Address - Fax:860-262-5672
Practice Address - Street 1:351 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3919
Practice Address - Country:US
Practice Address - Phone:860-262-5345
Practice Address - Fax:860-262-5672
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical