Provider Demographics
NPI:1457916397
Name:LAMBERT, JENNIFER ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3407
Mailing Address - Country:US
Mailing Address - Phone:860-271-5163
Mailing Address - Fax:
Practice Address - Street 1:611A LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4138
Practice Address - Country:US
Practice Address - Phone:860-405-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77811041C0700X
CT0077811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7781OtherCT LICENSE