Basic Information
| Provider Information | |||||||||
| NPI: | 1255896064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAGMARA NIECIKOWSKI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 RENN LN | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060373589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607485644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060521312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603483371 | ||||||||
| FaxNumber: | 8606120087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | NIECIKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | DAGMARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 8603483371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.