Healthcare Provider Details

I. General information

NPI: 1083117899
Provider Name (Legal Business Name): JULIE ADRIENNE LEVESQUE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 03/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAIN ST N STE 2B
WOODBURY CT
06798-2953
US

IV. Provider business mailing address

236 WASHINGTON RD
WOODBURY CT
06798-2807
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-3175
  • Fax: 844-364-2702
Mailing address:
  • Phone: 203-263-3793
  • Fax: 844-364-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3416
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: