Decosmo, Jennifer Lyne

Decosmo, Jennifer Lyne is an sole proprietor health care provider with primary practice located at 380 Main St , Wallingford CT 06492-2281. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Decosmo, Jennifer Lyne can be contacted via phone (203) 575-0466.

Contact Information

Primary practice address
380 Main St Wallingford CT 06492-2281
Phone: (203) 575-0466
Fax: (203) 575-1817
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 001917 Connecticut

Profile Details

NPI number 1649587924
LBN Legal business name Decosmo, Jennifer Lyne
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 8th, 2010
Last updated Feb 16th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649587924 NPPES
Connecticut MEDICAID 08037449

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