Provider Demographics
NPI:1568722882
Name:JOBERT, JENNIFER (MED LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JOBERT
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ELM ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3739
Mailing Address - Country:US
Mailing Address - Phone:860-741-3001
Mailing Address - Fax:860-741-8332
Practice Address - Street 1:113 ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3739
Practice Address - Country:US
Practice Address - Phone:860-741-3001
Practice Address - Fax:860-741-8332
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2839101Y00000X, 101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004121141Medicaid
321137OtherVALUE OPTIONS
201366OtherMHN
CT4553929OtherAETNA
CT191715000OtherMAGELLAN
CT211054OtherCOMP PSYCH