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General NPI Number Information
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NPI Number | 1609328921
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Entity Type | Individual
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Provider Name | JESSE JO TOTH-HENDERSON MA, RDT, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 203 MAIN STREET
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-975-7455
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Fax | 833-333-1452
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Provider Business Mailing Address
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Address Line | 32B MARLEN DR
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2226
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Country | US
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Telephone | 307-258-1326
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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 | 2609
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License Number State | CT
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