Individual
JENNIFER CAROL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
887 MAIN ST STE 1B, MONROE, CT 06468-2800
(203) 200-0847
Mailing address
18 AUNT PATTYS LN W, BETHEL, CT 06801-2912
(203) 451-0039
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
7606
CT
Other
Enumeration date
08/04/2022
Last updated
10/15/2024
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