Provider Demographics
NPI:1003825191
Name:EDGAR, JILL RAMSEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:RAMSEY
Last Name:EDGAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SWEET BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1513
Mailing Address - Country:US
Mailing Address - Phone:203-329-3398
Mailing Address - Fax:
Practice Address - Street 1:63 SWEET BRIAR RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1513
Practice Address - Country:US
Practice Address - Phone:203-329-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001700103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist