Healthcare Provider Details

I. General information

NPI: 1619653201
Provider Name (Legal Business Name): JESSICA LEA CHESBRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MAIN ST
NEW MILFORD CT
06776-2802
US

IV. Provider business mailing address

297 WELLSVILLE AVE
NEW MILFORD CT
06776-2328
US

V. Phone/Fax

Practice location:
  • Phone: 860-631-7476
  • Fax:
Mailing address:
  • Phone: 918-809-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number003841
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: