Basic Information
| Provider Information | |||||||||
| NPI: | 1760784250 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JSL CONNECTIONS, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | JESSICA S. LAROSA, LPC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 16 CORNERSTONE COURT | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | PLANTSVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602129534 | ||||||||
| FaxNumber: | 8606120087 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 CORNERSTONE COURT | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | PLANTSVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602129534 | ||||||||
| FaxNumber: | 8606120087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2010 | ||||||||
| LastUpdateDate: | 12/03/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LAROSA | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8602129534 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.