Basic Information
| Provider Information | |||||||||
| NPI: | 1689636045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMARAL | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 281 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608953015 | ||||||||
| FaxNumber: | 8605695905 | ||||||||
| Practice Location | |||||||||
| Address1: | 281 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9608953015 | ||||||||
| FaxNumber: | 8605695905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 003634 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 003634 | 01 | CT | LCSW LIC# | OTHER |