Basic Information
| Provider Information | |||||||||
| NPI: | 1568722882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOBERT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.ED LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 ELM ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607413001 | ||||||||
| FaxNumber: | 8607418332 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 ELM ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607413001 | ||||||||
| FaxNumber: | 8607418332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2839 | CT | Y | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 2839 | CT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 2839 | CT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 2839 | CT | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004121141 | 05 | CT | MEDICAID | 321137 | 01 | VALUE OPTIONS | OTHER | 201366 | 01 | MHN | OTHER | 4553929 | 01 | CT | AETNA | OTHER | 191715000 | 01 | CT | MAGELLAN | OTHER | 211054 | 01 | CT | COMP PSYCH | OTHER |