Provider Demographics
NPI:1467201236
Name:GULICK, EMMA (LMSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:GULICK
Suffix:
Gender:X
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 EVENING STAR DR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3547
Mailing Address - Country:US
Mailing Address - Phone:203-763-9638
Mailing Address - Fax:
Practice Address - Street 1:176 ROUTE 81
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419-1478
Practice Address - Country:US
Practice Address - Phone:860-996-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker