Provider Demographics
NPI:1043027022
Name:DEVONISH, IMAN (LMSW)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:DEVONISH
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 1:59 E EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1229
Mailing Address - Country:US
Mailing Address - Phone:860-985-3469
Mailing Address - Fax:
Practice Address - Street 1:71 W DUDLEY TOWN RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-5308
Practice Address - Country:US
Practice Address - Phone:860-888-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10661104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker