Provider Demographics
NPI:1851827760
Name:UNDER THE JEWEL TREE LLC
Entity Type:Organization
Organization Name:UNDER THE JEWEL TREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-454-4916
Mailing Address - Street 1:11 TURNER LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2009
Mailing Address - Country:US
Mailing Address - Phone:203-489-3711
Mailing Address - Fax:
Practice Address - Street 1:79 E PUTNAM AVE
Practice Address - Street 2:STE. 14
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5644
Practice Address - Country:US
Practice Address - Phone:203-489-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty