Provider Demographics
NPI:1184979130
Name:PIETRASIEWICZ, JESSICA (LPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:PIETRASIEWICZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 PADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7044
Mailing Address - Country:US
Mailing Address - Phone:860-657-8910
Mailing Address - Fax:860-657-8912
Practice Address - Street 1:110 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4371
Practice Address - Country:US
Practice Address - Phone:860-657-8910
Practice Address - Fax:860-657-8912
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2742101YP2500X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional