Provider Demographics
NPI:1053921007
Name:IANNUZZI, JENNIFER M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:IANNUZZI
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 1:49 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38A GROVE ST STE 101
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4664
Practice Address - Country:US
Practice Address - Phone:203-896-8888
Practice Address - Fax:203-403-9550
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0099551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical