Healthcare Provider Details

I. General information

NPI: 1629307913
Provider Name (Legal Business Name): JESSICA UZIEMBLO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 01/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 ALBANY AVE SUITE 203B
WEST HARTFORD CT
06117-2520
US

IV. Provider business mailing address

25 WILDERNESS WAY
WILLINGTON CT
06279-2322
US

V. Phone/Fax

Practice location:
  • Phone: 860-977-9358
  • Fax:
Mailing address:
  • Phone: 860-977-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002528
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: