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Individual
MR. MARK WILLIAM JAY
Active
Individual
MR. MARK WILLIAM JAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003395
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140003395CT04
ANTHEM BC
CT
01
—
189634
MANAGED HEALTH
—
01
—
P1120226
OXFORD
—
Enumeration date
03/21/2006
Last updated
12/17/2007
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