Provider Demographics
NPI:1730784216
Name:JETTE, AIMEE (LPC, ATR)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:JETTE
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 HIGH RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4913
Mailing Address - Country:US
Mailing Address - Phone:203-826-8983
Mailing Address - Fax:
Practice Address - Street 1:680 MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2656
Practice Address - Country:US
Practice Address - Phone:203-293-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional