Active NPI
Mia Marie Destefano, LMSW
- Social Worker
- Canton, CT
National Provider Identifier
1295673341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 8258
- Practice address
- 169 Albany Tpke Ste 4B
Canton, CT 06019-2511 - Phone
- (860) 626-5110
- NPI assigned
- Mar 23, 2026
- Last updated
- Mar 23, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 8258 | CT | Primary |
Addresses
Primary practice location
169 Albany Tpke Ste 4B
Canton, CT 06019-2511
Mailing address
218 New Britain Ave Apt 5
Unionville, CT 06085-1272
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8258 | CT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774224000000",
"number": "1295673341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 NEW BRITAIN AVE APT 5",
"city": "UNIONVILLE",
"state": "CT",
"postal_code": "060851272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 ALBANY TPKE STE 4B",
"city": "CANTON",
"state": "CT",
"postal_code": "060192511",
"telephone_number": "860-626-5110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "MIA",
"middle_name": "MARIE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-03-23",
"last_updated": "2026-03-23",
"certification_date": "2026-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CT",
"license": "8258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.