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General NPI Number Information
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NPI Number | 1316689078
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Entity Type | Individual
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Provider Name | JACOB VICENTE DNP, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 836 FARMINGTON AVE STE 109
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1544
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Country | US
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Telephone | 203-691-1685
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Fax | 203-891-6763
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Provider Business Mailing Address
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Address Line | 836 FARMINGTON AVE STE 109
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1544
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Country | US
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Telephone | 203-691-1685
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Fax | 203-891-6763
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2309147
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 14685
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 163WH0500X
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Taxonomy Name | Hemodialysis Registered Nurse
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License Number | RN2309147
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License Number State | MA
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