Provider Demographics
NPI:1265699813
Name:BAJOREK, GENEVA ANN (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:ANN
Last Name:BAJOREK
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3517
Mailing Address - Country:US
Mailing Address - Phone:860-645-1940
Mailing Address - Fax:
Practice Address - Street 1:32 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3517
Practice Address - Country:US
Practice Address - Phone:860-645-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
140003146CT01OtherANTHEM BLUE CROSS & BLUE SHIELD