Provider Demographics
NPI:1295100477
Name:DEFREITAS, JASON (MSW,BA,LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DEFREITAS
Suffix:
Gender:M
Credentials:MSW,BA,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:72 WEST ST
Practice Address - Street 2:DANBURY CLINICAL SERVICES
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6531
Practice Address - Country:US
Practice Address - Phone:203-797-9778
Practice Address - Fax:293-797-9858
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT2688104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherHEALTHYCT WELLMORE FACILITY/GRP
CT060669107OtherUBH-OXFORD LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE
CTD339229 -DANBURYOtherBEACON HEALTH STRATEGIES
CTNOT ELIGIBLEOtherMHN NETWORK
CT008064337Medicaid
CTNOT ELIGIBLEOtherMHN-TRICARE NOTH
CT13671433OtherCAQH
CTD339229 -DANBURYOtherBEACON HEALTH STRATEGIES