Provider Demographics
NPI:1558641290
Name:GAYESKI, JOANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:GAYESKI
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 1:55 TOWN LINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4317
Mailing Address - Country:US
Mailing Address - Phone:860-757-3702
Mailing Address - Fax:860-471-8255
Practice Address - Street 1:55 TOWN LINE RD STE 101
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4317
Practice Address - Country:US
Practice Address - Phone:860-757-3702
Practice Address - Fax:860-471-8255
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical