Provider Demographics
NPI:1114946530
Name:PASSARO, JENNIFER SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:PASSARO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUZANNE
Other - Last Name:SLEPIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7 COBBLE CT
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1593
Mailing Address - Country:US
Mailing Address - Phone:860-676-1001
Mailing Address - Fax:
Practice Address - Street 1:333 BLOOMFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1544
Practice Address - Country:US
Practice Address - Phone:860-236-1927
Practice Address - Fax:860-236-6483
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01422Medicare ID - Type Unspecified