Provider Demographics
NPI:1114913647
Name:SMITH, JANET M (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:S
Other - Last Name:ALEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 AVERILL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-1800
Mailing Address - Country:US
Mailing Address - Phone:860-928-5967
Mailing Address - Fax:860-928-9237
Practice Address - Street 1:100 AVERILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-1800
Practice Address - Country:US
Practice Address - Phone:860-928-5967
Practice Address - Fax:860-928-9237
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800000017Medicare PIN