Provider Demographics
NPI:1003251604
Name:DWYER, JENNIFER BUENZLE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BUENZLE
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CAMILLE
Other - Last Name:BUENZLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 YORK ST # T-209
Mailing Address - Street 2:YALE-NEW HAVEN HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-433-2788
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:20 YORK ST # T-209
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-433-2788
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT543292084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry