Jamie Marie Avallone, LCSW
Individual provider Active NPI Clinical Social Worker · Derby, CT
NPI 1053937342 · NPPES record last updated Nov 22, 2024
Key facts
- NPI
- 1053937342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 13795 (CT)
- Practice address
- 30 Elizabeth St
Derby, CT 06418-1869 - Phone
- (203) 954-0543
- NPI assigned
- Jun 22, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW | CT | MD | Social Worker |
| 13795 | CT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LCSW | CT | |
| Clinical Social Worker | 1041C0700X | 13795 | CT | Yes |
Addresses
Primary practice location
30 Elizabeth St
Derby, CT 06418-1869
Mailing address
133 Heatherwood Dr
Brookfield, CT 06804-3960
Other providers in Derby, CT
- Edinen Santhus Asuka
- Bahar Ataeinia
- Athena Counseling Services, LLC
- Ashlyn Augustine
- Pamela Austin
- Earl Lewin Baker
- Denise Barajas
- Shiza Bari
- Sarah R. Beard
- Elizabeth Belen
All providers in Derby, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.