Individual
JESSICA TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 FAITH LN, DANBURY, CT 06810-7122
(914) 629-2324
Mailing address
25 FAITH LN, DANBURY, CT 06810-7122
(914) 629-2324
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A
—
Enumeration date
05/26/2020
Last updated
05/26/2020
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