Provider Demographics
NPI:1245427566
Name:WUEST, JENNIFER LYONS (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYONS
Last Name:WUEST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:SUSAN
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:MA
Mailing Address - Zip Code:01032-0312
Mailing Address - Country:US
Mailing Address - Phone:203-767-5509
Mailing Address - Fax:
Practice Address - Street 1:69 HYDE HILL RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:MA
Practice Address - Zip Code:01032
Practice Address - Country:US
Practice Address - Phone:203-767-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056281041C0700X
MA1100191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800004218Medicare PIN