Healthcare Provider Details

I. General information

NPI: 1760320188
Provider Name (Legal Business Name): LAURA JARVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HAMMONASSETT MEADOWS RD
MADISON CT
06443-2012
US

IV. Provider business mailing address

12 HAMMONASSETT MEADOWS RD
MADISON CT
06443-2012
US

V. Phone/Fax

Practice location:
  • Phone: 203-804-3129
  • Fax:
Mailing address:
  • Phone: 203-804-3129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11272
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: