Healthcare Provider Details

I. General information

NPI: 1316862337
Provider Name (Legal Business Name): CONNECTICUT PSYCHTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BRIDGE SQ
WESTPORT CT
06880-5901
US

IV. Provider business mailing address

382 HIGH RIDGE DR
BRIDGEPORT CT
06606-4969
US

V. Phone/Fax

Practice location:
  • Phone: 646-470-1786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE NOEMI JIMENEZ
Title or Position: THERAPIST
Credential: LMSW
Phone: 227-213-3758