Healthcare Provider Details

I. General information

NPI: 1063229433
Provider Name (Legal Business Name): JENNIFER BISHOP LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST S
SOUTHBURY CT
06488-4237
US

IV. Provider business mailing address

143 FINCH AVE
MERIDEN CT
06451-2715
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-5078
  • Fax:
Mailing address:
  • Phone: 203-499-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7992
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: