Healthcare Provider Details

I. General information

NPI: 1689626871
Provider Name (Legal Business Name): MARY JANE PORADO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 JORDAN LN
WETHERSFIELD CT
06109-1128
US

IV. Provider business mailing address

13 NEWBERRY LN
GLASTONBURY CT
06033-2073
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-5572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005296
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: