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General NPI Number Information
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NPI Number | 1598303406
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Entity Type | Individual
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Provider Name | SUSANMARY CHRISTIN JANERICO
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Gender | Female
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 412 MAIN ST
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City | DANBURY
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State | CT
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Zip | 06810-4730
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Country | US
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Telephone | 203-730-8775
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Fax | 203-730-8807
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Provider Business Mailing Address
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Address Line | 412 MAIN ST
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City | DANBURY
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State | CT
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Zip | 06810-4730
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Country | US
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Telephone | 203-730-8775
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Fax | 203-730-8807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4077
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License Number State | CT
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