Healthcare Provider Details

I. General information

NPI: 1649692955
Provider Name (Legal Business Name): JANET STUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET STUCK DCH, FSAC

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 BOSTON POST RD
DARIEN CT
06820-4717
US

IV. Provider business mailing address

217 SPORT HILL RD
EASTON CT
06612-1833
US

V. Phone/Fax

Practice location:
  • Phone: 203-662-9602
  • Fax:
Mailing address:
  • Phone: 203-870-8529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1214
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: