Provider Demographics
NPI:1851439350
Name:RADWICK, JOANNE TERESA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:TERESA
Last Name:RADWICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:TERESA
Other - Last Name:PINHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-0561
Mailing Address - Country:US
Mailing Address - Phone:860-738-3000
Mailing Address - Fax:860-738-3000
Practice Address - Street 1:430 NILES RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057
Practice Address - Country:US
Practice Address - Phone:860-738-3000
Practice Address - Fax:860-738-3000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000473106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000473OtherLICENSE NUMBER
CT186805OtherMHN PROVIDER ID
CT410000473OtherBCBS PROVIDER ID
CT004195196Medicaid
CT207488OtherVALUE OPTIONS PRIVIDER ID