Healthcare Provider Details

I. General information

NPI: 1285217430
Provider Name (Legal Business Name): JENNA E ANGELLO LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 S HIGHLAND ST
WEST HARTFORD CT
06119-1826
US

IV. Provider business mailing address

45 INDIAN HILL AVE
PORTLAND CT
06480-1123
US

V. Phone/Fax

Practice location:
  • Phone: 860-258-4171
  • Fax:
Mailing address:
  • Phone: 860-965-9859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.004899
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: