Healthcare Provider Details

I. General information

NPI: 1912047267
Provider Name (Legal Business Name): JENNIFER ROKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER SPINO LCSW

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AVON MEADOW LN
AVON CT
06001-3753
US

IV. Provider business mailing address

108 COLONIAL ST
WEST HARTFORD CT
06110-1812
US

V. Phone/Fax

Practice location:
  • Phone: 860-878-2028
  • Fax:
Mailing address:
  • Phone: 203-525-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007375
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: