Provider Information for 1558012617
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Mrs. JENNIFER MARIE NEVADOMSKI LPC
Sex: Female
NPI: 1558012617
Last Updated: 2024-04-01
Certification Date: 2024-04-01
Certification Date: 2024-04-01
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1558012617 | ||||||||
| Enumeration Date | 2022-01-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 67 SHANE DR SOUTHBURY, CT 06488-2678 United States Phone: 516-204-2310 | Fax: | ||||||||
| Primary Practice Address | 153 S MAIN ST LOWER LEVEL, INSIDE BEAUTIFUL YOU SUITE NEWTOWN, CT 06470-1001 United States Phone: 203-632-9818 | Fax: | ||||||||
| Secondary Practice Address(es) | 67 SHANE DR | ||||||||
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