Provider Demographics
NPI:1033638457
Name:JESSICA MARKS, LPC LLC
Entity Type:Organization
Organization Name:JESSICA MARKS, LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-485-5536
Mailing Address - Street 1:360 RIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:CT
Mailing Address - Zip Code:06065-1102
Mailing Address - Country:US
Mailing Address - Phone:860-485-5536
Mailing Address - Fax:
Practice Address - Street 1:280 MAIN ST # C
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057-2748
Practice Address - Country:US
Practice Address - Phone:860-485-5536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health