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General NPI Number Information
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NPI Number | 1316525579
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Entity Type | Individual
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Provider Name | JESSICA RILEY GORMAN LADC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 10 WILLARD RD UNIT 358
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City | NORWALK
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State | CT
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Zip | 06851-7403
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Country | US
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Telephone | 203-722-6158
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ALGONQUIN RD
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City | NORWALK
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State | CT
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Zip | 06851-1820
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1622
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License Number State | CT
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