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General NPI Number Information
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NPI Number | 1265097034
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Entity Type | Individual
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Provider Name | JESSICA SANDRA MORNEAULT MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 85 FELT RD STE 605
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3871
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Country | US
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Telephone | 860-539-5628
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Fax |
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Provider Business Mailing Address
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Address Line | 503 REMINGTON ST STE 201
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City | FORT COLLINS
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State | CO
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Zip | 80524-3089
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Country | US
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Telephone | 970-541-4472
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW.0009922371
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09926860
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11413
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License Number State | CT
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