Provider Demographics
NPI:1780339200
Name:DAVILA, JESSICA MARIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1700
Mailing Address - Country:US
Mailing Address - Phone:203-255-5777
Mailing Address - Fax:203-259-9673
Practice Address - Street 1:125 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6611
Practice Address - Country:US
Practice Address - Phone:203-255-5777
Practice Address - Fax:203-259-9673
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT4145101YP2500X
CT005443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional