Provider Demographics
NPI:1295798643
Name:SALOOMEY, JAN (LPC)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:SALOOMEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3214
Mailing Address - Country:US
Mailing Address - Phone:203-263-4214
Mailing Address - Fax:203-266-0317
Practice Address - Street 1:22 FOX RUN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3214
Practice Address - Country:US
Practice Address - Phone:203-263-4214
Practice Address - Fax:203-266-0317
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000905OtherPROFESSIONAL COUNSELOR