Healthcare Provider Details

I. General information

NPI: 1699337519
Provider Name (Legal Business Name): JENNIE J ALBERT PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 HOMESTEAD DR
SOUTH WINDSOR CT
06074-2214
US

IV. Provider business mailing address

139 HOMESTEAD DR
SOUTH WINDSOR CT
06074-2214
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-7050
  • Fax:
Mailing address:
  • Phone: 860-798-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006690
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: