Provider Demographics
NPI:1457692782
Name:KARANJA, JEREMIAH M (LPC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:M
Last Name:KARANJA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MICHELLE LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1680
Mailing Address - Country:US
Mailing Address - Phone:860-324-3965
Mailing Address - Fax:
Practice Address - Street 1:593 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3038
Practice Address - Country:US
Practice Address - Phone:860-519-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46-002250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional