Provider Demographics
NPI:1780999482
Name:WELLS BROWN, JENNIFER (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WELLS BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2415 BOSTON POST RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4348
Mailing Address - Country:US
Mailing Address - Phone:203-693-4566
Mailing Address - Fax:203-457-5970
Practice Address - Street 1:2415 BOSTON POST RD
Practice Address - Street 2:UNIT 12
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4348
Practice Address - Country:US
Practice Address - Phone:203-693-4566
Practice Address - Fax:203-457-5970
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001922101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health