Provider Demographics
NPI:1164667978
Name:JANUSH, LAUREN J (APRN-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:JANUSH
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEIGS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3057
Mailing Address - Country:US
Mailing Address - Phone:203-204-3901
Mailing Address - Fax:475-234-3932
Practice Address - Street 1:15 MEIGS AVE STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3057
Practice Address - Country:US
Practice Address - Phone:203-204-3901
Practice Address - Fax:475-234-3932
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003746364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent