Active NPI
Jennifer Christianson, LPC
- Professional Counselor
- Norwich, CT
National Provider Identifier
1518435841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3615
- Practice address
- 119 Lafayette St
Norwich, CT 06360-2708 - Phone
- (860) 889-0097
- Fax
- (860) 969-0879
- NPI assigned
- Nov 5, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3615 | CT | Primary |
| Mental Health Counselor | 101YM0800X | 3615 | CT |
Addresses
Primary practice location
119 Lafayette St
Norwich, CT 06360-2708
Mailing address
119 Lafayette St
Norwich, CT 06360-2708
Phone (860) 460-9906
Other practice location 1
18 Oneco St Ste 3
Norwich, CT 06360-3440
Phone (860) 460-9906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240719000210 | CT | Practitioner - Mental Health Counselor | 3476099094 | Practice locations: Norwich, CT |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3615 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affinity Behavioral Health, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716076800000",
"number": "1518435841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 LAFAYETTE ST",
"city": "NORWICH",
"state": "CT",
"postal_code": "063602708",
"telephone_number": "860-460-9906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 LAFAYETTE ST",
"city": "NORWICH",
"state": "CT",
"postal_code": "063602708",
"telephone_number": "860-889-0097",
"fax_number": "860-969-0879"
}
],
"practiceLocations": [
{
"address_1": "18 Oneco St Ste 3",
"address_purpose": "LOCATION",
"city": "Norwich",
"state": "CT",
"postal_code": "063603440",
"country_code": "US",
"telephone_number": "860-460-9906",
"fax_number": "860-969-0879",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHRISTIANSON",
"first_name": "JENNIFER",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-05",
"last_updated": "2024-05-19",
"certification_date": "2024-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "3615",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CT",
"license": "3615",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.