Provider Demographics
NPI:1245955020
Name:JENNIFER ESPINOZA PSYD LLC
Entity type:Organization
Organization Name:JENNIFER ESPINOZA PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-638-8518
Mailing Address - Street 1:47 CIDER BROOK DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3263
Mailing Address - Country:US
Mailing Address - Phone:860-638-8518
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2701
Practice Address - Country:US
Practice Address - Phone:860-783-8852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty