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Contact Information

JACQUELYNN RUSSO BOUDINOT, LMFT, NCC, CDM
90 MAIN ST STE 103A
CENTERBROOK, CT06409-1057
 Phone: 860-510-6130
 Fax: 860-760-6706
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Marriage & Family Therapist

106H00000X
 

Mental Health

101YM0800X
 

Professional

101YP2500X
Indicates primary specialty

NPI Profile & details for JACQUELYNN RUSSO BOUDINOT · (Female)

NPI Number 1538521927
Status Active
Credentials LMFT, NCC, CDM
Entity Individual
Enumeration date 03/24/2016
Last updated 01/18/2024 - About 2 years ago
Sole proprietor 1 Yes
Identifiers
  • CT License # 1806
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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