Provider Demographics
NPI:1215112404
Name:SLATTERY, EMILY ALLISON (LMSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ALLISON
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHURCH HILL RD STE GL1
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1194
Mailing Address - Country:US
Mailing Address - Phone:203-648-5983
Mailing Address - Fax:203-491-2900
Practice Address - Street 1:107 CHURCH HILL RD STE GL1
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:203-648-5983
Practice Address - Fax:203-491-2900
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid