Healthcare Provider Details

I. General information

NPI: 1417411729
Provider Name (Legal Business Name): JENNIFER LEE ERIKSSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HARTFORD TPKE
TOLLAND CT
06084-2842
US

IV. Provider business mailing address

158 FOREST ST APT 805
MANCHESTER CT
06040-5968
US

V. Phone/Fax

Practice location:
  • Phone: 860-952-9092
  • Fax:
Mailing address:
  • Phone: 860-952-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003194
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003194
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: