Provider Demographics
NPI:1891233656
Name:JEAN, PRISCILLA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 HOMESTEAD AVE
Mailing Address - Street 2:COMMUNITY RENEWAL TEAM INC
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-527-8106
Mailing Address - Fax:
Practice Address - Street 1:333 HOMESTEAD AVE
Practice Address - Street 2:COMMUNITY RENEWAL TEAM INC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2155
Practice Address - Country:US
Practice Address - Phone:860-527-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker