Provider Demographics
NPI:1225105216
Name:STERN, JANNETTE (JANNETTE STERN, LCSW)
Entity Type:Individual
Prefix:
First Name:JANNETTE
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:JANNETTE STERN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W MAIN ST
Mailing Address - Street 2:SUITE 106B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4501
Mailing Address - Country:US
Mailing Address - Phone:203-353-8446
Mailing Address - Fax:203-353-8446
Practice Address - Street 1:2001 W MAIN ST
Practice Address - Street 2:SUITE 106B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4501
Practice Address - Country:US
Practice Address - Phone:203-353-8446
Practice Address - Fax:203-353-8446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3634405OtherOXFORD HEALTH PLANS
CT7062814OtherAETNA INSURANCE
CT326457OtherMHN INSURANCE
CT11510066OtherCAQH PROVIDER ID
CT140005991CT01OtherANTHEM BC BS