Provider Demographics
NPI:1730070483
Name:LAGOSH, TIMOTHY THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:THOMAS
Last Name:LAGOSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310401
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06131-0401
Mailing Address - Country:US
Mailing Address - Phone:860-817-8739
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 310401
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06131-0401
Practice Address - Country:US
Practice Address - Phone:860-817-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT155251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical