Provider Demographics
NPI:1093990996
Name:JAINCHILL, LISA JENNY (CAC, LADC, MSW, CCDP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JENNY
Last Name:JAINCHILL
Suffix:
Gender:F
Credentials:CAC, LADC, MSW, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WADSWORTH STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-527-1124
Mailing Address - Fax:860-724-2539
Practice Address - Street 1:45 WADSWORTH STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-527-1124
Practice Address - Fax:860-724-2539
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CT25452104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)