Individual
CARLY RAE JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
325 DANBURY RD, NEW MILFORD, CT 06776-4344
(860) 354-8556
Mailing address
75 WEST ST, DANBURY, CT 06810-6528
(860) 354-8556
(860) 354-3975
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
MSW.005035
CT
1041C0700X
Clinical Social Worker
Primary
012182
CT
Other
Enumeration date
06/29/2021
Last updated
05/20/2022
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