Provider Demographics
NPI:1518524156
Name:MINIERI, JESSICA SUDOL (LPC, LMSW, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SUDOL
Last Name:MINIERI
Suffix:
Gender:F
Credentials:LPC, LMSW, LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SPINELLI
Other - Last Name:SUDOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 ORCHID DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7293
Mailing Address - Country:US
Mailing Address - Phone:518-534-4119
Mailing Address - Fax:
Practice Address - Street 1:5 ORCHID DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7293
Practice Address - Country:US
Practice Address - Phone:518-534-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3944101YP2500X
CT69771041C0700X
225C00000X
NY002961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor