Individual
JACQUELYNN RUSSO-BOUDINOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, NCC, CDM
Contact information
Practice address
90 MAIN ST STE 103A, CENTERBROOK, CT 06409-1057
(860) 510-6130
(860) 760-6706
Mailing address
90 MAIN ST STE 103A, CENTERBROOK, CT 06409-1057
(860) 510-6130
(860) 760-6706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
1806
CT
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
03/24/2016
Last updated
01/18/2024
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