Provider Demographics
NPI:1609328921
Name:TOTH-HENDERSON, JESSE JO (MA, RDT, LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSE
Middle Name:JO
Last Name:TOTH-HENDERSON
Suffix:
Gender:F
Credentials:MA, RDT, LPC
Other - Prefix:MRS
Other - First Name:JESSE
Other - Middle Name:JO
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, RDT, LPC
Mailing Address - Street 1:32B MARLEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2226
Mailing Address - Country:US
Mailing Address - Phone:307-258-1326
Mailing Address - Fax:
Practice Address - Street 1:203 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-975-7455
Practice Address - Fax:833-333-1452
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional