Provider Demographics
NPI:1134132780
Name:ARSENAULT, JENIFER ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:ROSE
Last Name:ARSENAULT
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 1:41 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3633
Mailing Address - Country:US
Mailing Address - Phone:860-276-9295
Mailing Address - Fax:860-276-9296
Practice Address - Street 1:226 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1167
Practice Address - Country:US
Practice Address - Phone:860-276-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11241139OtherCAQH NUMBER