Provider Demographics
NPI:1275130320
Name:BUKOWSKI, JILL D (LMFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:BUKOWSKI
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 1:353 MCCLINTOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2018
Mailing Address - Country:US
Mailing Address - Phone:860-797-5812
Mailing Address - Fax:
Practice Address - Street 1:353 MCCLINTOCK ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2018
Practice Address - Country:US
Practice Address - Phone:860-797-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2478106H00000X
CT2968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist