Provider Demographics
NPI:1033362132
Name:SCHOENLEBER, JEAN STAUFFER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:STAUFFER
Last Name:SCHOENLEBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:FITZGERALD
Other - Last Name:STAUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:30 ELIZABETH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1802
Mailing Address - Country:US
Mailing Address - Phone:203-954-0543
Mailing Address - Fax:203-954-0544
Practice Address - Street 1:30 ELIZABETH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1802
Practice Address - Country:US
Practice Address - Phone:203-954-0543
Practice Address - Fax:203-954-0544
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical