Healthcare Provider Details

I. General information

NPI: 1720561327
Provider Name (Legal Business Name): JESSICA VENTURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 CEDAR ST
NEW HAVEN CT
06519-1610
US

IV. Provider business mailing address

232 CEDAR ST
NEW HAVEN CT
06519-1610
US

V. Phone/Fax

Practice location:
  • Phone: 203-634-7080
  • Fax:
Mailing address:
  • Phone: 203-634-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9921
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: