Provider Demographics
NPI:1205579372
Name:JOZEFIAK, JESSICA (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JOZEFIAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261-9302
Mailing Address - Country:US
Mailing Address - Phone:305-308-5977
Mailing Address - Fax:
Practice Address - Street 1:909 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:POWNAL
Practice Address - State:VT
Practice Address - Zip Code:05261-9302
Practice Address - Country:US
Practice Address - Phone:305-308-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100.0314017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty