Healthcare Provider Details

I. General information

NPI: 1346611852
Provider Name (Legal Business Name): JESSIKA BRASSEAUX APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BREWERY ST UNIT 9138
NEW HAVEN CT
06511-5954
US

IV. Provider business mailing address

PO BOX 9138
NEW HAVEN CT
06532-0138
US

V. Phone/Fax

Practice location:
  • Phone: 203-903-9797
  • Fax: 844-440-2333
Mailing address:
  • Phone: 203-903-9797
  • Fax: 844-440-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number113883
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6319
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: