1720323165 NPI number — MRS. JANIS HERLTH GIFFORD MSW, LPC, NBCC

Table of content: MRS. JANIS HERLTH GIFFORD MSW, LPC, NBCC (NPI 1720323165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720323165 NPI number — MRS. JANIS HERLTH GIFFORD MSW, LPC, NBCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIFFORD
Provider First Name:
JANIS
Provider Middle Name:
HERLTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LPC, NBCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720323165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 MAIN STREET
Provider Second Line Business Mailing Address:
STEPNEY BAPTIST CHURCH
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-255-3401
Provider Business Mailing Address Fax Number:
203-268-1621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 MAIN STREET
Provider Second Line Business Practice Location Address:
STEPNEY BAPTIST CHURCH
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-255-3401
Provider Business Practice Location Address Fax Number:
203-268-1621
Provider Enumeration Date:
12/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  001908 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 001908 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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