Provider Demographics
NPI:1669859617
Name:FALL, JANET (MT-BC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:STREIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:122 WINDSOR AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1678 MERIDEN-WATERBURY TURNPIKE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-518-5557
Practice Address - Fax:888-200-4093
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT05102225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist