Provider Demographics
NPI:1598325482
Name:SPOONER, JENNIFER RACHEL
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHEL
Last Name:SPOONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2328
Mailing Address - Country:US
Mailing Address - Phone:860-908-0797
Mailing Address - Fax:
Practice Address - Street 1:241 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-2328
Practice Address - Country:US
Practice Address - Phone:860-908-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional