Provider Demographics
NPI:1710453220
Name:JENNIFER B STAEHLY LCSW LLC
Entity Type:Organization
Organization Name:JENNIFER B STAEHLY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAEHLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-575-9891
Mailing Address - Street 1:229 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06423-1425
Mailing Address - Country:US
Mailing Address - Phone:860-575-9891
Mailing Address - Fax:
Practice Address - Street 1:276 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2952
Practice Address - Country:US
Practice Address - Phone:860-575-9891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health