Provider Demographics
NPI:1619368677
Name:FEJOS, MADELEINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:
Last Name:FEJOS
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 1:69 BROADFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1543
Mailing Address - Country:US
Mailing Address - Phone:203-433-7223
Mailing Address - Fax:203-646-6612
Practice Address - Street 1:451 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-433-7223
Practice Address - Fax:203-646-6612
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075581041C0700X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008057976Medicaid
CTCTGA000481OtherCTGA
CTCTGA000481OtherCTGA