Provider Demographics
NPI:1568894491
Name:PATRICIA M JARVIS, LPC. LLC
Entity Type:Organization
Organization Name:PATRICIA M JARVIS, LPC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-989-0601
Mailing Address - Street 1:1100 NEW BRITAIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2427
Mailing Address - Country:US
Mailing Address - Phone:860-989-0601
Mailing Address - Fax:
Practice Address - Street 1:1100 NEW BRITAIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2427
Practice Address - Country:US
Practice Address - Phone:860-989-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty