Provider Demographics
NPI:1912288812
Name:CONNELL, JANICE M (LMSW,CASAC,CSAT)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:M
Last Name:CONNELL
Suffix:
Gender:F
Credentials:LMSW,CASAC,CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KAIN RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3720
Mailing Address - Country:US
Mailing Address - Phone:845-987-9886
Mailing Address - Fax:845-987-9886
Practice Address - Street 1:28 KAIN RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3720
Practice Address - Country:US
Practice Address - Phone:845-987-9886
Practice Address - Fax:845-987-9886
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0641961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical