Provider Demographics
NPI:1720577646
Name:LASSMAN, JENNIFER ELANA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELANA
Last Name:LASSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FRONT ST APT 505
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2851
Mailing Address - Country:US
Mailing Address - Phone:203-988-4189
Mailing Address - Fax:
Practice Address - Street 1:20 FRONT ST APT 505
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:203-988-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-09-05
Deactivation Date:2018-05-08
Deactivation Code:
Reactivation Date:2018-09-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor