Healthcare Provider Details

I. General information

NPI: 1093384273
Provider Name (Legal Business Name): JENNIFER BAILEY RESNICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KRISTEN BAILEY

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N MAIN ST
ENFIELD CT
06082-3372
US

IV. Provider business mailing address

575 MAIN ST FL 2
MIDDLETOWN CT
06457-2845
US

V. Phone/Fax

Practice location:
  • Phone: 602-539-0248
  • Fax:
Mailing address:
  • Phone: 203-748-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12148
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: