Provider Demographics
NPI:1962033142
Name:TRASLAVINA, JENNEFER
Entity Type:Individual
Prefix:MISS
First Name:JENNEFER
Middle Name:
Last Name:TRASLAVINA
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 1:3851 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2864
Mailing Address - Country:US
Mailing Address - Phone:203-372-3333
Mailing Address - Fax:203-374-7515
Practice Address - Street 1:3851 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2864
Practice Address - Country:US
Practice Address - Phone:203-372-3333
Practice Address - Fax:203-374-7515
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)