Provider Demographics
NPI:1285612499
Name:LAHAN, CAROL MERCER (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MERCER
Last Name:LAHAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-1600
Mailing Address - Country:US
Mailing Address - Phone:860-886-2569
Mailing Address - Fax:860-889-6761
Practice Address - Street 1:276 SCOTLAND ROAD
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-886-2569
Practice Address - Fax:860-889-6761
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT079267OtherHEALTHNET
CT140000220CT01OtherANTHEM BLUE CROSS
CT079267OtherHEALTHNET