Provider Demographics
NPI:1225676562
Name:PLAGESSE, JACQUELYN MARIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:PLAGESSE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 EAST ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5838
Mailing Address - Country:US
Mailing Address - Phone:203-562-2101
Mailing Address - Fax:
Practice Address - Street 1:311 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5838
Practice Address - Country:US
Practice Address - Phone:203-562-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist