Individual
JASON DEFREITAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW,BA,LMSW
Contact information
Practice address
72 WEST ST, DANBURY CLINICAL SERVICES, DANBURY, CT 06810-6531
(203) 797-9778
(293) 797-9858
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTRATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2688
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008064337
—
CT
01
—
060669107
ANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT
01
—
13671433
CAQH
CT
01
—
D339229 -DANBURY
BEACON HEALTH STRATEGIES
CT
01
—
NOT ELIGIBLE
MHN NETWORK
CT
01
—
PENDING
AETNA BEHAVIORAL HEALTH
CT
Enumeration date
12/14/2015
Last updated
05/12/2016
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