Healthcare Provider Details

I. General information

NPI: 1043052673
Provider Name (Legal Business Name): JUSTINE ELISE JARVIE ASSOCIATE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CT-81 BUILDING 2, UNIT D
KILLINGWORTH CT
06419
US

IV. Provider business mailing address

176 CT-81 BUILDING 2, UNIT D
KILLINGWORTH CT
06419
US

V. Phone/Fax

Practice location:
  • Phone: 860-269-0703
  • Fax:
Mailing address:
  • Phone: 860-269-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3402
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: