Healthcare Provider Details

I. General information

NPI: 1174486864
Provider Name (Legal Business Name): MARISKA JEN MIESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CORPORATE DR STE 950
SHELTON CT
06484-6246
US

IV. Provider business mailing address

363 SUMMERFIELD GDNS
SHELTON CT
06484-6306
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-0224
  • Fax:
Mailing address:
  • Phone: 562-477-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9182
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: