Healthcare Provider Details

I. General information

NPI: 1093063364
Provider Name (Legal Business Name): SHERI JONES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 COMMERCE AVE
DANIELSON CT
06239-2804
US

IV. Provider business mailing address

37 COMMERCE AVE
DANIELSON CT
06239-2804
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-7179
  • Fax: 860-779-6526
Mailing address:
  • Phone: 860-774-7179
  • Fax: 860-779-6526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002455
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGH57134
Identifier TypeMEDICAID
Identifier StateRI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: