Provider Demographics
NPI:1124215546
Name:FONFARA, JANINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:
Last Name:FONFARA
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 1:112 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2737
Mailing Address - Country:US
Mailing Address - Phone:860-425-8735
Mailing Address - Fax:
Practice Address - Street 1:163 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1022
Practice Address - Country:US
Practice Address - Phone:860-537-4601
Practice Address - Fax:860-537-6935
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical