Provider Demographics
NPI:1174538029
Name:GEIDA, JANINE MARIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JANINE
Middle Name:MARIE
Last Name:GEIDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1413
Mailing Address - Country:US
Mailing Address - Phone:860-325-0904
Mailing Address - Fax:
Practice Address - Street 1:56 DEAN RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1413
Practice Address - Country:US
Practice Address - Phone:860-325-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist