=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255594438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN EGAN CFLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2008
-----------------------------------------------------
Last Update Date | 07/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 WOODS HOLLOW RD
-----------------------------------------------------
City | WEST SUFFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06093-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-668-4466
-----------------------------------------------------
Fax | 860-668-1474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 WOODS HOLLOW RD
-----------------------------------------------------
City | WEST SUFFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06093-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-668-4466
-----------------------------------------------------
Fax | 860-668-1474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------