Provider Demographics
NPI:1639378953
Name:MESSERE, JARA J (LCSW)
Entity Type:Individual
Prefix:
First Name:JARA
Middle Name:J
Last Name:MESSERE
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 1:267 WILLIMANTIC RD
Mailing Address - Street 2:
Mailing Address - City:CHAPLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06235-2516
Mailing Address - Country:US
Mailing Address - Phone:860-617-1089
Mailing Address - Fax:
Practice Address - Street 1:267 WILLIMANTIC RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHAPLIN
Practice Address - State:CT
Practice Address - Zip Code:06235-2516
Practice Address - Country:US
Practice Address - Phone:860-617-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066091041C0700X
CT1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool