Provider Demographics
NPI:1003963620
Name:MAHIEU, JANICE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:MAHIEU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MAIN ST STE 231
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5839
Mailing Address - Country:US
Mailing Address - Phone:203-375-5782
Mailing Address - Fax:203-375-3048
Practice Address - Street 1:30 FERRY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6016
Practice Address - Country:US
Practice Address - Phone:203-375-5782
Practice Address - Fax:203-375-3048
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical