Provider Demographics
NPI:1235670035
Name:KERELEJZA, NATACHA JABOIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NATACHA
Middle Name:JABOIN
Last Name:KERELEJZA
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:P.O. BOX 1907
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7059
Mailing Address - Country:US
Mailing Address - Phone:203-910-8079
Mailing Address - Fax:203-405-5803
Practice Address - Street 1:290 PRATT STREET
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8600
Practice Address - Country:US
Practice Address - Phone:203-910-8079
Practice Address - Fax:203-405-5003
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0064211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical