Healthcare Provider Details

I. General information

NPI: 1013090380
Provider Name (Legal Business Name): JEANNE B AYOTTE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E MAIN ST
CLINTON CT
06413-2114
US

IV. Provider business mailing address

5 HAMMOCK PKWY
CLINTON CT
06413-2304
US

V. Phone/Fax

Practice location:
  • Phone: 860-575-1545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000630
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: