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NPI Code Detail

MEDICARE: JESSICA RADCLIFF LPC

MEDICARE: JESSICA RADCLIFF LPC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1811326002
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RADCLIFF LPC
Provider Business Mailing Address
First Line : 331 WETHERSFIELD AVENUE
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1420
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 331 WETHERSFIELD AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1438
Country : US
Telephone Number : 860-236-4511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2013
Last Update Date : 12/22/2023

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