Provider Demographics
NPI:1194109736
Name:WILSON, JANET N (MFT)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MUNGER LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:CT
Mailing Address - Zip Code:06751-1704
Mailing Address - Country:US
Mailing Address - Phone:203-266-5882
Mailing Address - Fax:203-266-5882
Practice Address - Street 1:258 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1815
Practice Address - Country:US
Practice Address - Phone:203-565-7399
Practice Address - Fax:203-283-2345
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist