Provider Demographics
NPI:1558012617
Name:NEVADOMSKI, JENNIFER MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:NEVADOMSKI
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 1:67 SHANE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2678
Mailing Address - Country:US
Mailing Address - Phone:516-204-2310
Mailing Address - Fax:
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:LOWER LEVEL, INSIDE BEAUTIFUL YOU SUITE
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1001
Practice Address - Country:US
Practice Address - Phone:203-632-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional