Organization
MIDDLESEX WELLNESS & MEDIATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYNN RUSSO-BOUDINOT LMFT, NCC (OWNER)
(860) 510-6130
Entity
Organization
Contact information
Practice address
80-1 PLAINS RD, ESSEX, CT 06426-1501
(860) 510-6130
(860) 760-6706
Mailing address
80-1 PLAINS RD, ESSEX, CT 06426-1501
(860) 510-6130
(860) 760-6706
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
1806
CT
Other
Enumeration date
03/29/2016
Last updated
03/29/2016
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