Provider Demographics
NPI:1669680740
Name:JANETATOS, THERESA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:JANETATOS
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 1:44 PROSPECT PARK W
Mailing Address - Street 2:APT. A3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2363
Mailing Address - Country:US
Mailing Address - Phone:917-929-6412
Mailing Address - Fax:718-768-0109
Practice Address - Street 1:44 PROSPECT PARK W
Practice Address - Street 2:APT. A3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2363
Practice Address - Country:US
Practice Address - Phone:917-929-6412
Practice Address - Fax:718-768-0109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039026-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical