Provider Demographics
NPI:1760665020
Name:CHASE, JENNIFER M (ATR-BC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:CHASE
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:GOSSELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR-BC, LPC
Mailing Address - Street 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2919
Mailing Address - Country:US
Mailing Address - Phone:203-606-1228
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-606-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional