Provider Demographics
NPI:1568799625
Name:JANIS, CAROLYN E (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:E
Last Name:JANIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:E
Other - Last Name:HEIMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:92 MAIN ST
Mailing Address - Street 2:UNIT 205
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 WELLES ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4205
Practice Address - Country:US
Practice Address - Phone:860-652-0428
Practice Address - Fax:860-652-0081
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0067391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical