Healthcare Provider Details

I. General information

NPI: 1730954397
Provider Name (Legal Business Name): JESSICA FERGUSON LMFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 PARK ROAD EXT STE 108
MIDDLEBURY CT
06762-1833
US

IV. Provider business mailing address

199 PARK ROAD EXT STE 108
MIDDLEBURY CT
06762-1833
US

V. Phone/Fax

Practice location:
  • Phone: 860-940-0473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA LYNN LAPORTA
Title or Position: OWNER
Credential: LMFT
Phone: 860-940-0473