Provider Demographics
NPI:1265792691
Name:BUNNELL, JENNIFER L (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BUNNELL
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 1:10 CENTER ST
Mailing Address - Street 2:APT B
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3107
Mailing Address - Country:US
Mailing Address - Phone:860-908-8920
Mailing Address - Fax:
Practice Address - Street 1:16 BRACE RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1825
Practice Address - Country:US
Practice Address - Phone:860-782-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health