Provider Demographics
NPI:1417183716
Name:MINER, JEAN LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:LOUISE
Last Name:MINER
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 1:165 STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6397
Mailing Address - Country:US
Mailing Address - Phone:860-443-0036
Mailing Address - Fax:860-439-6423
Practice Address - Street 1:165 STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6397
Practice Address - Country:US
Practice Address - Phone:860-443-0036
Practice Address - Fax:860-439-6423
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical