MEDICARE: JESSICA TRZASKA LPC, ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001721	CT

General Provider Information

NPI Number	:	1265912125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TRZASKA LPC, ATR-BC

Provider Business Mailing Address
First Line	:	653 W MAIN ST
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-4825
Country	:	US
Telephone Number	:	203-623-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 W MAIN ST
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-4826
Country	:	US
Telephone Number	:	203-339-1062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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