Nancy Caron Wall, MS LMFT
Individual provider Active NPI Marriage & Family Therapist · Chesire, CT
NPI 1104971035 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104971035
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 000675 (CT)
- Practice address
- 345 Highland Ave
102
Chesire, CT 06410-1246 - Phone
- (203) 699-9996
- Fax
- (203) 271-3575
- NPI assigned
- Jan 23, 2007
- 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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000675 | CT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 000675 | CT | Yes |
Addresses
Primary practice location
345 Highland Ave
102
Chesire, CT 06410-1246
Mailing address
PO Box 463
Plantsville, CT 06479-1323
Phone (203) 699-9996
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.