Doctor Name: | JACQUELINE TESTA |
NPI Number: | 1154679280 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 002227 |
Business Practice Address: | 115 Bridge St East Windsor, CT - 060889547 |
Business Phone Number: | 8602545127 |
Business Fax Number: | 8602545254 |
Mailing Address: | 115 Bridge St, EAST WINDSOR |
State: | CT |
Postal Code: | 060889547 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/21/2012 |
NPI Last Update Date: | 08/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 002227 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |