Provider Demographics
NPI:1114120276
Name:SPERANZA, MARYJANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARYJANE
Middle Name:
Last Name:SPERANZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 GRANNIS ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1504
Mailing Address - Country:US
Mailing Address - Phone:203-376-8891
Mailing Address - Fax:
Practice Address - Street 1:259 GRANNIS ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-1504
Practice Address - Country:US
Practice Address - Phone:203-376-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT--1631101YP2500X
CT001631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor