Healthcare Provider Details

I. General information

NPI: 1043170772
Provider Name (Legal Business Name): JESSICA E TRESSELT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 HIGHLAND AVE
CHESHIRE CT
06410-2550
US

IV. Provider business mailing address

17 ANTHONY RD
NORTH HAVEN CT
06473-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-599-1492
  • Fax:
Mailing address:
  • Phone: 203-599-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9121
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: