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General NPI Number Information
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NPI Number | 1013295005
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Entity Type | Individual
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Provider Name | JESS EDELSTEIN PHD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 475 BUCKLAND RD STE 103
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3738
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Country | US
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Telephone | 860-670-5207
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Fax | 860-432-4540
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Provider Business Mailing Address
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Address Line | 36 ELLSWORTH LN
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City | ELLINGTON
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State | CT
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Zip | 06029-2105
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Country | US
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Telephone | 860-670-5207
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Fax | 860-432-4540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 003147
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License Number State | CT
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