Healthcare Provider Details

I. General information

NPI: 1912594714
Provider Name (Legal Business Name): JESSICA UZARSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 STATE ST
NORTH HAVEN CT
06473-3108
US

IV. Provider business mailing address

1 LONG WHARF DR STE 321
NEW HAVEN CT
06511-5946
US

V. Phone/Fax

Practice location:
  • Phone: 203-781-4600
  • Fax: 203-781-4624
Mailing address:
  • Phone: 203-781-4600
  • Fax: 203-781-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11295
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: