Provider Demographics
NPI:1861584393
Name:WOLF, JESSICA VETRANO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:VETRANO
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:VETRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14 SPARROW LANE
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085
Mailing Address - Country:US
Mailing Address - Phone:860-673-5146
Mailing Address - Fax:860-276-9296
Practice Address - Street 1:41 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-276-9295
Practice Address - Fax:860-276-9295
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004717103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical