Provider Demographics
NPI:1205612611
Name:HERBST, JESSICA MARIE (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:HERBST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WEST AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4042
Mailing Address - Country:US
Mailing Address - Phone:516-660-6220
Mailing Address - Fax:
Practice Address - Street 1:49 DAY ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-4901
Practice Address - Country:US
Practice Address - Phone:203-854-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist