License Detail

NameWAGMAN JACQUELINE BLOOM
AddressWESTPORTCT
ProfessionLICENSED CLINICAL SOCIAL WORK
License No027289
Date of Licensure09/01/04  (OriginallylicensedasaCertifiedSocialWorkeron12/31/81)
Additional QualificationR -Psychotherapy Privilege
StatusREGISTERED
Registered through last day of

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