Provider Demographics
NPI:1326297052
Name:ELISOFON, JANE PAULETTE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:PAULETTE
Last Name:ELISOFON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:PAULETTE
Other - Last Name:WECHSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:898 ETHAN ALLEN HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877
Mailing Address - Country:US
Mailing Address - Phone:203-431-3830
Mailing Address - Fax:914-617-2031
Practice Address - Street 1:898 ETHAN ALLEN HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:203-431-3830
Practice Address - Fax:914-617-2031
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT#0008521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical