Healthcare Provider Details

I. General information

NPI: 1376901124
Provider Name (Legal Business Name): JESSE MANCINONE MS, L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 GILLETTE RD
NEW HARTFORD CT
06057-2808
US

IV. Provider business mailing address

202 GILLETTE RD
NEW HARTFORD CT
06057-2808
US

V. Phone/Fax

Practice location:
  • Phone: 860-782-0868
  • Fax:
Mailing address:
  • Phone: 860-782-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002872
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: