Provider Demographics
NPI:1649692955
Name:STUCK, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:STUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:STUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DCH, FSAC
Mailing Address - Street 1:217 SPORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1833
Mailing Address - Country:US
Mailing Address - Phone:203-870-8529
Mailing Address - Fax:
Practice Address - Street 1:688 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4717
Practice Address - Country:US
Practice Address - Phone:203-662-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1214171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator