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General NPI Number Information
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NPI Number | 1518524156
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Entity Type | Individual
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Provider Name | JESSICA SUDOL MINIERI LPC, LMSW, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 5 ORCHID DR
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City | DANBURY
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State | CT
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Zip | 06810-7293
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Country | US
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Telephone | 518-534-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ORCHID DR
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City | DANBURY
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State | CT
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Zip | 06810-7293
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Country | US
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Telephone | 518-534-4119
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3944
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License Number State | CT
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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 | 6977
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002961
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License Number State | NY
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