Provider Demographics
NPI:1144857665
Name:SIMMONS, JENNIFER SAUCIER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SAUCIER
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:SAUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-2017
Mailing Address - Country:US
Mailing Address - Phone:860-877-0870
Mailing Address - Fax:
Practice Address - Street 1:212 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-2017
Practice Address - Country:US
Practice Address - Phone:860-877-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional