Individual
JENNIFER LYN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
743 SOUTH AVE, BRIDGEPORT, CT 06604-5810
(203) 330-6000
(203) 382-1435
Mailing address
743 SOUTH AVE, BRIDGEPORT, CT 06604-5810
(203) 330-6000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
007975
CT
Other
Enumeration date
05/23/2018
Last updated
05/23/2018
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