Doctor Name: | MS. JANINE FONFARA |
NPI Number: | 1124215546 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 004773 |
Business Practice Address: | 163 Broadway St Colchester, CT - 064151022 |
Business Phone Number: | 8605374601 |
Business Fax Number: | 8605376935 |
Mailing Address: | 112 Lafayette St, NORWICH |
State: | CT |
Postal Code: | 063602737 |
Phone Number: | 8604258735 |
Fax Number: | |
NPI Enumeration Date: | 09/30/2007 |
NPI Last Update Date: | 02/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 004773 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |