Provider Demographics
NPI:1982716635
Name:AMENTA, JEANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:AMENTA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WALKLEY ML
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1071
Mailing Address - Country:US
Mailing Address - Phone:860-944-9252
Mailing Address - Fax:860-664-5575
Practice Address - Street 1:2257 SILAS DEANE HWY STE 4
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2328
Practice Address - Country:US
Practice Address - Phone:860-944-9252
Practice Address - Fax:860-664-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004228674-00Medicaid