Provider Demographics
NPI:1821332115
Name:GIETEK, JENIFER L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:L
Last Name:GIETEK
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:PO BOX 128
Mailing Address - Street 2:SUITE 4
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:860-454-8775
Practice Address - Street 1:129 TOLLAND STAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2343
Practice Address - Country:US
Practice Address - Phone:860-863-4732
Practice Address - Fax:860-454-8775
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
CT0080701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical