Provider Demographics
NPI:1740752856
Name:DEWITT, JENNIFER LYNN (LADC, LMFT, CAC, CPS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DEWITT
Suffix:
Gender:F
Credentials:LADC, LMFT, CAC, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FLANDERS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2103
Mailing Address - Country:US
Mailing Address - Phone:203-565-6385
Mailing Address - Fax:
Practice Address - Street 1:22 CHASE RIVER RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1408
Practice Address - Country:US
Practice Address - Phone:203-537-2153
Practice Address - Fax:203-756-6032
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001150101YA0400X
CTCPS-3902405300000X
CT001937106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional