Provider Demographics
NPI:1457687626
Name:ANDERSON, JENNIFER MOREL (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOREL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CARMAN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1717
Mailing Address - Country:US
Mailing Address - Phone:860-644-1791
Mailing Address - Fax:
Practice Address - Street 1:17 CARMAN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1717
Practice Address - Country:US
Practice Address - Phone:860-644-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist