Provider Demographics
NPI:1265097034
Name:MORNEAULT, JESSICA SANDRA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SANDRA
Last Name:MORNEAULT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 REMINGTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3089
Mailing Address - Country:US
Mailing Address - Phone:970-541-4472
Mailing Address - Fax:
Practice Address - Street 1:85 FELT RD STE 605
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3871
Practice Address - Country:US
Practice Address - Phone:860-539-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009922371104100000X
CO099268601041C0700X
CT114131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker