Provider Demographics
NPI:1730391830
Name:MITCHELL-CORSINO, JESSICA A (PSYD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:MITCHELL-CORSINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:45 S MAIN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2402
Mailing Address - Country:US
Mailing Address - Phone:959-888-3901
Mailing Address - Fax:
Practice Address - Street 1:45 S MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2402
Practice Address - Country:US
Practice Address - Phone:959-888-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical