Healthcare Provider Details

I. General information

NPI: 1427015429
Provider Name (Legal Business Name): JERI HEPWORTH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WOODLAND ST ASYLUM HILL FAMILY MEDICINE CENTER, INC.
HARTFORD CT
06105-1207
US

IV. Provider business mailing address

99 WOODLAND ST ASYLUM HILL FAMILY MEDICINE CENTER, INC.
HARTFORD CT
06105-1207
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4212
  • Fax: 860-714-8080
Mailing address:
  • Phone: 860-714-4212
  • Fax: 860-714-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000033
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: