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General NPI Number Information
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NPI Number | 1033638457
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Entity Type | Organization
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Legal Business Name | JESSICA MARKS, LPC LLC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 280 MAIN ST # C
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City | NEW HARTFORD
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State | CT
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Zip | 06057-2748
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Country | US
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Telephone | 860-485-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 360 RIVERTON RD
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City | RIVERTON
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State | CT
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Zip | 06065-1102
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Country | US
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Telephone | 860-485-5536
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. JESSICA MARKS
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Credential | LPC
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Telephone | 860-485-5536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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