Healthcare Provider Details

I. General information

NPI: 1154045557
Provider Name (Legal Business Name): JENEE MIDGETTE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 S MAIN ST STE 214
WEST HARTFORD CT
06107-2403
US

IV. Provider business mailing address

276 WAWARME AVE APT B
HARTFORD CT
06114-1512
US

V. Phone/Fax

Practice location:
  • Phone: 860-538-5693
  • Fax:
Mailing address:
  • Phone: 860-538-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5822
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: