Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | CT |
NPI | 1003432733 |
---|---|
Provider Name | Mia Laleh Tabib |
First Address | North Haven, CT 06473-1715 |
Second Address | Branford, CT 06405-6518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2020 |
Last Update Date | 18/06/2020 |