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General NPI Number Information
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NPI Number | 1891980678
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES JESKI LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 1169 ELLINGTON RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3515
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Country | US
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Telephone | 860-324-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 512 MAIN ST
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City | NEWINGTON
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State | CT
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Zip | 06111-2413
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Country | US
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Telephone | 860-324-2840
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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 | 08334
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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