Provider Demographics
NPI:1407408115
Name:PINTO-SAMUDA, JAYANN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAYANN
Middle Name:L
Last Name:PINTO-SAMUDA
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 1:2550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:860-726-7836
Practice Address - Street 1:2550 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1936
Practice Address - Country:US
Practice Address - Phone:860-548-0101
Practice Address - Fax:860-726-7836
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 1041S0200X
CT104701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool