Provider Demographics
NPI:1962174508
Name:ALCARAZ, JENNA ROSE (LPC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:ALCARAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ROSE
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 CEDAR ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2655
Mailing Address - Country:US
Mailing Address - Phone:860-577-2127
Mailing Address - Fax:
Practice Address - Street 1:66 CEDAR ST STE 208
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2655
Practice Address - Country:US
Practice Address - Phone:860-577-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5859101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor