Provider Demographics
NPI:1336838507
Name:TEMELSIZ, JACQUELYN (LMFT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:TEMELSIZ
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 AMERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-6033
Mailing Address - Country:US
Mailing Address - Phone:203-521-3462
Mailing Address - Fax:
Practice Address - Street 1:27 AMERIDGE DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-6033
Practice Address - Country:US
Practice Address - Phone:203-521-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist