Provider Demographics
NPI:1124859137
Name:JESSICA DESAI LLC
Entity type:Organization
Organization Name:JESSICA DESAI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-212-9924
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-0144
Mailing Address - Country:US
Mailing Address - Phone:203-212-9924
Mailing Address - Fax:
Practice Address - Street 1:203 SAMP MORTAR DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-2463
Practice Address - Country:US
Practice Address - Phone:203-212-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty