Individual
JESSICA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
11 HIGH ST STE 209, SUFFIELD, CT 06078-2125
(860) 578-2141
Mailing address
PO BOX 25, ELLINGTON, CT 06029-0025
(702) 286-7557
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11763
CT
1041C0700X
Clinical Social Worker
1727
CT
Other
Enumeration date
06/22/2020
Last updated
11/13/2024
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