Provider Demographics
NPI:1265552475
Name:HUMPHREYS, NANCY D (MS, MSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:D
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:MS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MAIN ST
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5839
Mailing Address - Country:US
Mailing Address - Phone:203-733-9877
Mailing Address - Fax:203-304-1229
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-733-9877
Practice Address - Fax:203-304-1229
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003090-1101YM0800X
CT000401101YP2500X
CT0069651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional