Provider Demographics
NPI:1992046338
Name:FECTEAU, JOHN PATRICK (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:FECTEAU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FREY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-2724
Mailing Address - Country:US
Mailing Address - Phone:203-756-8984
Mailing Address - Fax:203-756-8984
Practice Address - Street 1:900 WATERTOWN AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2011
Practice Address - Country:US
Practice Address - Phone:203-756-8984
Practice Address - Fax:230-756-8984
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical