Provider Demographics
NPI:1750674032
Name:MILNE, JENNI LORRAINE (MS, LADC, SCPG)
Entity Type:Individual
Prefix:MS
First Name:JENNI
Middle Name:LORRAINE
Last Name:MILNE
Suffix:
Gender:F
Credentials:MS, LADC, SCPG
Other - Prefix:MS
Other - First Name:JENNI
Other - Middle Name:LORRAINE
Other - Last Name:MILNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LADC
Mailing Address - Street 1:38 OLD RIDGEBURY RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5128
Mailing Address - Country:US
Mailing Address - Phone:203-792-4515
Mailing Address - Fax:203-748-2604
Practice Address - Street 1:62 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3547
Practice Address - Country:US
Practice Address - Phone:860-355-7312
Practice Address - Fax:860-354-7023
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000925101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00925Medicaid
CT008031626Medicaid
CT008017939Medicaid
CT004257516Medicaid
CT004123840Medicaid