Healthcare Provider Details

I. General information

NPI: 1366919722
Provider Name (Legal Business Name): JILLIAN BEDNARZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WINCHESTER AVE FL 2
NEW HAVEN CT
06511-1131
US

IV. Provider business mailing address

800 WINCHESTER AVE FL 2
NEW HAVEN CT
06511-1131
US

V. Phone/Fax

Practice location:
  • Phone: 617-545-5233
  • Fax: 917-732-7755
Mailing address:
  • Phone: 617-545-5233
  • Fax: 917-732-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: