| Hathaway Lcsw Llc | |
|
87 Broadway St Colchester CT 06415-1057 | |
| (869) 537-5280 | |
| Not Available |
| Full Name | Hathaway Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 87 Broadway St, Colchester, Connecticut |
| Authorized Official Name and Position | Melanie Hathaway (OWNER) |
| Authorized Official Contact | 8605375280 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hathaway Lcsw Llc 87 Broadway St Colchester CT 06415-1057 Ph: (869) 537-5280 | Hathaway Lcsw Llc 87 Broadway St Colchester CT 06415-1057 Ph: (869) 537-5280 |
| NPI Number | 1780037911 |
|---|---|
| Provider Enumeration Date | 07/23/2016 |
| Last Update Date | 07/23/2016 |
| Medicare PECOS PAC ID | 5395031801 |
|---|---|
| Medicare Enrollment ID | O20160909001117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780037911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 008016 (Connecticut) | Primary |
| Provider Name | Melanie G Hathaway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609123934 PECOS PAC ID: 0345499703 Enrollment ID: I20121001000140 |
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