Basic Information
| Provider Information | |||||||||
| NPI: | 1497849699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEAN | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 664 PROSPECT AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061054203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602334830 | ||||||||
| FaxNumber: | 8602316222 | ||||||||
| Practice Location | |||||||||
| Address1: | 664 PROSPECT AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061054203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602334830 | ||||||||
| FaxNumber: | 8602316222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 000077 | CT | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 000424 | CT | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.