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General NPI Number Information
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NPI Number | 1780182162
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Entity Type | Organization
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Legal Business Name | JESSICA GRZYWINSKI LLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 435 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3720
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Country | US
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Telephone | 978-807-9922
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Fax | 978-807-9922
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Provider Business Mailing Address
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Address Line | 805 SWAMP RD
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City | COVENTRY
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State | CT
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Zip | 06238-1440
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Country | US
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Telephone | 978-807-9922
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MRS. JESSICA L GRZYWINSKI
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Credential | LMFT
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Telephone | 978-807-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1962
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License Number State | CT
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