Provider Demographics
NPI:1679866230
Name:DAGENAIS, JESSICA LEE (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:DAGENAIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:STEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-0021
Mailing Address - Country:US
Mailing Address - Phone:413-595-2079
Mailing Address - Fax:860-971-3364
Practice Address - Street 1:2 ALLEN ST STE F
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036-9552
Practice Address - Country:US
Practice Address - Phone:513-817-1487
Practice Address - Fax:860-971-3364
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8450101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health