Provider Demographics
NPI:1306623145
Name:MONARCA, JACKSON (LPC)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:MONARCA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JACKSON
Other - Middle Name:ANTHONY
Other - Last Name:MONARCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1302 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1302 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4515
Practice Address - Country:US
Practice Address - Phone:203-401-4453
Practice Address - Fax:203-401-4457
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health