Provider Demographics
NPI:1720323165
Name:GIFFORD, JANIS HERLTH (MSW, LPC, NBCC)
Entity type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:HERLTH
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MSW, LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 MAIN STREET
Mailing Address - Street 2:STEPNEY BAPTIST CHURCH
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468
Mailing Address - Country:US
Mailing Address - Phone:203-255-3401
Mailing Address - Fax:203-268-1621
Practice Address - Street 1:423 MAIN STREET
Practice Address - Street 2:STEPNEY BAPTIST CHURCH
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468
Practice Address - Country:US
Practice Address - Phone:203-255-3401
Practice Address - Fax:203-268-1621
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001908101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health