Healthcare Provider Details

I. General information

NPI: 1235434085
Provider Name (Legal Business Name): JESSICA ALEJANDRO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WAY RD
MIDDLEFIELD CT
06455-1080
US

IV. Provider business mailing address

941 SLATER RD
NEW BRITAIN CT
06053
US

V. Phone/Fax

Practice location:
  • Phone: 860-680-5238
  • Fax:
Mailing address:
  • Phone: 860-680-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001435
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: