Provider Demographics
NPI:1902225923
Name:BROSNAN, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BROSNAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 PLAINFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CT
Mailing Address - Zip Code:06377-2003
Mailing Address - Country:US
Mailing Address - Phone:607-713-3993
Mailing Address - Fax:
Practice Address - Street 1:910 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CT
Practice Address - Zip Code:06377-2003
Practice Address - Country:US
Practice Address - Phone:860-771-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6793101YM0800X
RIMHC00880101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health