| Doctor Name: | MRS. JENNIFER ALICE TATTERSALL |
| NPI Number: | 1013095231 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 005582 |
| Business Practice Address: | 401 West Thames Street Southeastern Mental Health Authority Bldg 301 Norwich, CT - 06360 |
| Business Phone Number: | 8608594674 |
| Business Fax Number: | 8608594790 |
| Mailing Address: | 401 West Thames Street, Southeastern Mental Health Authority Bldg 301 NORWICH |
| State: | CT |
| Postal Code: | 06360 |
| Phone Number: | 8608594674 |
| Fax Number: | 8608594790 |
| NPI Enumeration Date: | 11/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 005582 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |