Individual
MS. JESSICA W. SORMRUDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, LCSW
Contact information
Practice address
11 MAIN ST STE 3G, MYSTIC, CT 06355-3654
(860) 889-8346
Mailing address
11 MAIN ST STE 3G, MYSTIC, CT 06355-3654
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10935
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
CT
Enumeration date
11/17/2017
Last updated
11/03/2020
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