MEDICARE: MS. JAN SALOOMEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	000905	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000905	OTHER	CT	PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1295798643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAN SALOOMEY LPC

Provider Business Mailing Address
First Line	:	22 FOX RUN
Second Line	:
City	:	WOODBURY
State	:	CT
Zip	:	06798-3214
Country	:	US
Telephone Number	:	203-263-4214
Fax Number	:	203-266-0317

Provider Business Practice Location Address
First Line	:	22 FOX RUN
Second Line	:
City	:	WOODBURY
State	:	CT
Zip	:	06798-3214
Country	:	US
Telephone Number	:	203-263-4214
Fax Number	:	203-266-0317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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