Provider Demographics
NPI:1982113379
Name:EPPS, JEFF (LADC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:EPPS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6805
Mailing Address - Country:US
Mailing Address - Phone:203-820-1570
Mailing Address - Fax:
Practice Address - Street 1:189 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6805
Practice Address - Country:US
Practice Address - Phone:203-820-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1255101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)