Healthcare Provider Details

I. General information

NPI: 1760816458
Provider Name (Legal Business Name): JESSICA LEIGH CHITTENDEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 FENN ST ADMINISTRATIVE OFFICES
PITTSFIELD MA
01201-5261
US

IV. Provider business mailing address

42 SUMMER ST ADMINISTRATIVE OFFICES
PITTSFIELD MA
01201
US

V. Phone/Fax

Practice location:
  • Phone: 413-629-1251
  • Fax: 413-448-2198
Mailing address:
  • Phone: 413-442-0402
  • Fax: 413-442-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: