Organization
JENNIFER SMITH, LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SMITH (LCSW)
(860) 581-0215
Entity
Organization
Contact information
Practice address
65 S COLONY ST, WALLINGFORD, CT 06492-4150
(860) 581-0215
Mailing address
83 HIGH HILL RD, WALLINGFORD, CT 06492-1903
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008057515
—
CT
Enumeration date
08/02/2017
Last updated
08/02/2017
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