Provider Demographics
NPI:1770681348
Name:SOLEK-TEFFT, JANICE LEE (MA LIC CMHC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LEE
Last Name:SOLEK-TEFFT
Suffix:
Gender:F
Credentials:MA LIC CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BLAKEY RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9492
Mailing Address - Country:US
Mailing Address - Phone:802-660-2827
Mailing Address - Fax:802-899-4113
Practice Address - Street 1:14 BLAKEY RD
Practice Address - Street 2:
Practice Address - City:UNDERHILL
Practice Address - State:VT
Practice Address - Zip Code:05489-9492
Practice Address - Country:US
Practice Address - Phone:802-660-2827
Practice Address - Fax:802-899-4113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007159Medicaid
VT068-0000147OtherCMHC LICENSE