MEDICARE: MR. TIMOTHY JAMES JESKI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	08334	CT
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1891980678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY JAMES JESKI LCSW

Provider Business Mailing Address
First Line	:	512 MAIN ST
Second Line	:
City	:	NEWINGTON
State	:	CT
Zip	:	06111-2413
Country	:	US
Telephone Number	:	860-324-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1169 ELLINGTON RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3515
Country	:	US
Telephone Number	:	860-324-2840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	05/18/2022

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