Provider Demographics
NPI:1720576846
Name:THEROUX, STEFANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:THEROUX
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 1:24 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3312
Mailing Address - Country:US
Mailing Address - Phone:203-288-8904
Mailing Address - Fax:
Practice Address - Street 1:24 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3312
Practice Address - Country:US
Practice Address - Phone:203-288-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical