Provider Demographics
NPI:1407437056
Name:JSB WELLNESS LLC
Entity Type:Organization
Organization Name:JSB WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA-BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:203-781-6635
Mailing Address - Street 1:3000 WHITNEY AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2353
Mailing Address - Country:US
Mailing Address - Phone:203-781-6635
Mailing Address - Fax:
Practice Address - Street 1:3000 WHITNEY AVE STE 125
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2353
Practice Address - Country:US
Practice Address - Phone:203-781-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty