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General NPI Number Information
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NPI Number | 1629961123
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Entity Type | Individual
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Provider Name | JENNIFER A PROFFITT
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2 FOREST PARK DR STE 2-2-LM
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City | FARMINGTON
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State | CT
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Zip | 06032-1445
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Country | US
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Telephone | 860-383-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 500 OLD FARMS RD
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City | AVON
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State | CT
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Zip | 06001-2716
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Country | US
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Telephone | 860-919-3210
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 231
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License Number State | CT
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