Provider Demographics
NPI:1275177404
Name:LISTORTI, JESSICA (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LISTORTI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:CT
Mailing Address - Zip Code:06058-0303
Mailing Address - Country:US
Mailing Address - Phone:860-307-3974
Mailing Address - Fax:
Practice Address - Street 1:693 BLOOMFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2489
Practice Address - Country:US
Practice Address - Phone:860-697-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT85242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry