Individual
MISS JENNIFER LYNE DECOSMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
380 MAIN ST, WALLINGFORD, CT 06492-2281
(203) 575-0466
(203) 575-1817
Mailing address
380 MAIN ST, WALLINGFORD, CT 06492-2281
(203) 575-0466
(203) 575-1817
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001917
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08037449
—
CT
Enumeration date
09/08/2010
Last updated
02/16/2022
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