Provider Demographics
NPI:1053024158
Name:BELIN, JESSICA LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:BELIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LEWIS ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5226
Mailing Address - Country:US
Mailing Address - Phone:203-606-5024
Mailing Address - Fax:
Practice Address - Street 1:103 LEWIS ST FL 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5226
Practice Address - Country:US
Practice Address - Phone:203-606-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.006049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT46.006049OtherSTATE OF CONNECTICUT, DEPARTMENT OF PUBLIC HEALTH