Provider Demographics
NPI:1679055974
Name:KMETZ, JEANNE LEAVEY (LPC, MA)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:LEAVEY
Last Name:KMETZ
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COATES FARM RD
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1342
Mailing Address - Country:US
Mailing Address - Phone:860-208-3984
Mailing Address - Fax:
Practice Address - Street 1:475 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3738
Practice Address - Country:US
Practice Address - Phone:860-208-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional