| Doctor Name: | DR. JESS EDELSTEIN |
| NPI Number: | 1013295005 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | |
| Business Practice Address: | 85 Felt Rd Suite 605 South Windsor, CT - 060743870 |
| Business Phone Number: | 8606705207 |
| Business Fax Number: | |
| Mailing Address: | 85 Felt Rd, Suite 605 SOUTH WINDSOR |
| State: | CT |
| Postal Code: | 060743870 |
| Phone Number: | 8606705207 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2011 |
| NPI Last Update Date: | 04/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |