Provider Demographics
NPI:1992122535
Name:BIELAWA, JEANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:BIELAWA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PEACEFUL DR
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3215
Mailing Address - Country:US
Mailing Address - Phone:203-733-0816
Mailing Address - Fax:203-738-1188
Practice Address - Street 1:405 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-743-4412
Practice Address - Fax:203-738-1188
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003240101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008075146Medicaid