Provider Demographics
NPI:1265779136
Name:RICHARDS, JESSICA ANNE (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:RICHARDS
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 1:100 ROSCOMMON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1591
Mailing Address - Country:US
Mailing Address - Phone:860-343-5500
Mailing Address - Fax:860-343-5509
Practice Address - Street 1:100 ROSCOMMON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1591
Practice Address - Country:US
Practice Address - Phone:860-343-5500
Practice Address - Fax:860-343-5509
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional