Healthcare Provider Details

I. General information

NPI: 1851802193
Provider Name (Legal Business Name): JESSICA PYKA LPC 8483
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARINE ST STE 5
THOMASTON CT
06787-1470
US

IV. Provider business mailing address

10 MARINE ST STE 5
THOMASTON CT
06787-1470
US

V. Phone/Fax

Practice location:
  • Phone: 860-458-6921
  • Fax:
Mailing address:
  • Phone: 860-458-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: