Healthcare Provider Details

I. General information

NPI: 1124483144
Provider Name (Legal Business Name): JERRI ANN LEVENSON HAMBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JERRI ANN MCINTYRE

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MANSFIELD AVE
WILLIMANTIC CT
06226-2027
US

IV. Provider business mailing address

46 WOODLAWN DR
COVENTRY CT
06238-2545
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax:
Mailing address:
  • Phone: 860-908-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001122
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: