Provider Demographics
NPI:1124105564
Name:ZAINALVAND, GERALDA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GERALDA
Middle Name:
Last Name:ZAINALVAND
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 1:500 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1639
Mailing Address - Country:US
Mailing Address - Phone:860-293-6342
Mailing Address - Fax:
Practice Address - Street 1:500 VINE ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1639
Practice Address - Country:US
Practice Address - Phone:860-293-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040705Medicaid