Provider Demographics
NPI:1326186107
Name:LEWIS, JESSICA BETH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:BETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 CHERRY ST
Mailing Address - Street 2:#121
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3466
Mailing Address - Country:US
Mailing Address - Phone:203-314-2901
Mailing Address - Fax:
Practice Address - Street 1:167 CHERRY ST
Practice Address - Street 2:#121
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3466
Practice Address - Country:US
Practice Address - Phone:203-314-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist