Provider Demographics
NPI:1215386586
Name:MIGNOSA, CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:MIGNOSA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BUSINESS PARK DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2931
Mailing Address - Country:US
Mailing Address - Phone:203-433-0299
Mailing Address - Fax:203-643-2042
Practice Address - Street 1:9 BUSINESS PARK DR UNIT 1
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2931
Practice Address - Country:US
Practice Address - Phone:203-433-0299
Practice Address - Fax:203-643-2042
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical