Healthcare Provider Details

I. General information

NPI: 1689587859
Provider Name (Legal Business Name): LEAH JESSE HARTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PROSPECT ST
BRISTOL CT
06010-5071
US

IV. Provider business mailing address

15 PLYMOUTH LN
BOLTON CT
06043-7313
US

V. Phone/Fax

Practice location:
  • Phone: 860-584-2105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: