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General NPI Number Information
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NPI Number | 1871305359
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Entity Type | Individual
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Provider Name | JEFFREY ALLEN SIC MA, LPCA
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Gender | Male
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 35 NOD RD STE 202
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City | AVON
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State | CT
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Zip | 06001-3826
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Country | US
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Telephone | 860-207-9449
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MOUNTAIN VIEW DR
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City | PLAINVILLE
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State | CT
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Zip | 06062-3243
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Country | US
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Telephone | 860-550-4385
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8052
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License Number State | CT
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