Provider Demographics
NPI:1609899376
Name:DEVITO, JENNIFER L (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:DEVITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:BENNETT BEHAVIORAL HEALTH CENTER
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-276-7242
Mailing Address - Fax:203-276-7799
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:BENNETT BEHAVIORAL HEALTH CENTER
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-7242
Practice Address - Fax:203-276-7799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005915104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker