Provider Demographics
NPI:1346611852
Name:BRASSEAUX, JESSIKA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:BRASSEAUX
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BREWERY ST UNIT 9138
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06532-7716
Mailing Address - Country:US
Mailing Address - Phone:203-903-9728
Mailing Address - Fax:
Practice Address - Street 1:50 BREWERY ST UNIT 9138
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5954
Practice Address - Country:US
Practice Address - Phone:203-903-9728
Practice Address - Fax:585-229-8307
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT113883163WP0808X
CT6319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health