Healthcare Provider Details

I. General information

NPI: 1043228067
Provider Name (Legal Business Name): ERIN C JANICEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN PATTERSON MSW

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VAUXHALL STREET
NEW LONDON CT
06320
US

IV. Provider business mailing address

7 LEARY DRIVE
WATERFORD CT
06385
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-2797
  • Fax: 860-701-3776
Mailing address:
  • Phone: 860-444-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6602
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: