Provider Demographics
NPI:1285085811
Name:STAUNTON, ANDREW (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:STAUNTON
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 1:17 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06375-1318
Mailing Address - Country:US
Mailing Address - Phone:860-886-7500
Mailing Address - Fax:
Practice Address - Street 1:2 CLINIC DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2916
Practice Address - Country:US
Practice Address - Phone:860-886-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical