Basic Information
| Provider Information | |||||||||
| NPI: | 1770813669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | JANNET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 E MAIN ST | ||||||||
| Address2: | 4TH FLOOR ADMINISTRATION | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035749000 | ||||||||
| FaxNumber: | 2035749006 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035749000 | ||||||||
| FaxNumber: | 2035749006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2009 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 060669107 | 01 | CT | HEALTHYCT WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | CONNECTICARE/UBH WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | UNITED HEALTHCARE/UBH WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | OXNARD/FREEDOM LIBERTY/UBH WELLMORE GRP/FACILITY | OTHER | PENDING | 01 | CT | CIGNA BEHAVIORAL HEALTH | OTHER | 060669107 | 01 | CT | AETNA BEHAVIORAL HEALTH | OTHER | NOT ELIGIBLE | 01 | CT | MHN MANAGED HEALTH NETWORK | OTHER | 060669107 | 01 | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY | OTHER | NOT ELIGIBLE | 01 | CT | MHN TRICARENORTH | OTHER | 004039202 | 05 | CT | MEDICAID | 13528679 | 01 | CT | CAQH | OTHER |