Healthcare Provider Details

I. General information

NPI: 1285041699
Provider Name (Legal Business Name): JASON KERSTEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MIGEON AVE
TORRINGTON CT
06790-4643
US

IV. Provider business mailing address

469 MIGEON AVE
TORRINGTON CT
06790-4643
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-0931
  • Fax: 860-489-3325
Mailing address:
  • Phone: 860-489-0931
  • Fax: 860-489-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008059
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: