Basic Information
| Provider Information | |||||||||
| NPI: | 1407083843 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEFFREY A ASMAR LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WRIGHT RD | ||||||||
| Address2: | |||||||||
| City: | COLLINSVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060193744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606939009 | ||||||||
| FaxNumber: | 8602316222 | ||||||||
| Practice Location | |||||||||
| Address1: | 664 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061054203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603240742 | ||||||||
| FaxNumber: | 8602316222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 06/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | ASMAR | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8603240742 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 006147 | CT | Y | Agencies | Community/Behavioral Health |
No ID Information.