Individual
JESSICA R PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
125 PENFIELD RD, FAIRFIELD, CT 06824-6611
(203) 255-5777
(203) 368-9167
Mailing address
125 PENFIELD RD, FAIRFIELD, CT 06824-6611
(203) 255-5777
(203) 368-9167
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
001292
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004069985
—
CT
Enumeration date
02/11/2012
Last updated
05/08/2018
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