Provider Demographics
NPI:1639261449
Name:SMITH, JO ANNE NANCY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JO ANNE
Middle Name:NANCY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JO ANNE
Other - Middle Name:SCIALLO
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:883 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2729
Mailing Address - Country:US
Mailing Address - Phone:203-243-8796
Mailing Address - Fax:
Practice Address - Street 1:883 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-2729
Practice Address - Country:US
Practice Address - Phone:203-243-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
180231OtherMHN
336637OtherHEALTHNET
6239332OtherUNITED HEALTH