Provider Demographics
NPI:1063780542
Name:MARKS, JESSICA (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LAVALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:331 WETHERSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1420
Mailing Address - Country:US
Mailing Address - Phone:860-236-4511
Mailing Address - Fax:869-231-8449
Practice Address - Street 1:331 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1420
Practice Address - Country:US
Practice Address - Phone:860-236-4511
Practice Address - Fax:869-231-8449
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health