Provider Demographics
NPI:1487755278
Name:CRNIC, JACQUELINE ANN (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN
Last Name:CRNIC
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6021
Mailing Address - Country:US
Mailing Address - Phone:203-792-6060
Mailing Address - Fax:
Practice Address - Street 1:84 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6021
Practice Address - Country:US
Practice Address - Phone:203-792-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005995104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker