Provider Demographics
NPI:1023485208
Name:ADELMAN, JESSICA LEE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:ADELMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 QUENTIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2321
Mailing Address - Country:US
Mailing Address - Phone:860-778-6814
Mailing Address - Fax:
Practice Address - Street 1:51 GILLETT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2636
Practice Address - Country:US
Practice Address - Phone:860-778-6814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10.121925163WP0808X
CT12.006576363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003745Medicaid
CT004041000Medicaid