| Jennifer B Staehly Lcsw Llc | |
|
276 S Main St Colchester CT 06415-2952 | |
| (860) 575-9891 | |
| Not Available |
| Full Name | Jennifer B Staehly Lcsw Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 276 S Main St, Colchester, Connecticut |
| Authorized Official Name and Position | Jennifer B Staehly (THERAPIST) |
| Authorized Official Contact | 8605759891 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer B Staehly Lcsw Llc 229 Town St East Haddam CT 06423-1425 Ph: (860) 575-9891 | Jennifer B Staehly Lcsw Llc 276 S Main St Colchester CT 06415-2952 Ph: (860) 575-9891 |
| NPI Number | 1710453220 |
|---|---|
| Provider Enumeration Date | 10/23/2018 |
| Last Update Date | 10/23/2018 |
| Medicare PECOS PAC ID | 4183030323 |
|---|---|
| Medicare Enrollment ID | O20210312000324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710453220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer Staehly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215325097 PECOS PAC ID: 9739405960 Enrollment ID: I20150306001137 |
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