MEDICARE: MS. GENEVA ANN BAJOREK MSW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	003146	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140003146CT01	OTHER		ANTHEM BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1265699813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GENEVA ANN BAJOREK MSW LCSW

Provider Business Mailing Address
First Line	:	32 WASHINGTON ST
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-3517
Country	:	US
Telephone Number	:	860-645-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 WASHINGTON ST
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-3517
Country	:	US
Telephone Number	:	860-645-1940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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