Provider Demographics
NPI:1689091308
Name:JENIFER L GIETEK LCSW LLC
Entity Type:Organization
Organization Name:JENIFER L GIETEK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GIETEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-508-6633
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-0128
Mailing Address - Country:US
Mailing Address - Phone:860-508-6633
Mailing Address - Fax:
Practice Address - Street 1:891 MAIN STREET
Practice Address - Street 2:2ND FLOOR OFFICE D
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073
Practice Address - Country:US
Practice Address - Phone:860-508-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008070251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health