Provider Demographics
NPI:1972052207
Name:FIERRO, ANGELA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:FIERRO
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 1:140 GLASTONBURY BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4402
Mailing Address - Country:US
Mailing Address - Phone:860-878-2150
Mailing Address - Fax:
Practice Address - Street 1:140 GLASTONBURY BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4402
Practice Address - Country:US
Practice Address - Phone:860-878-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical