Provider Demographics
NPI:1265912125
Name:TRZASKA, JESSICA (LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TRZASKA
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DETLEFSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:653 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4825
Mailing Address - Country:US
Mailing Address - Phone:203-623-8944
Mailing Address - Fax:
Practice Address - Street 1:672 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4826
Practice Address - Country:US
Practice Address - Phone:203-339-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty