Provider Demographics
NPI:1043885379
Name:GARFINKLE, JONATHAN RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:GARFINKLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAPLE VALE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1100
Mailing Address - Country:US
Mailing Address - Phone:203-997-7630
Mailing Address - Fax:
Practice Address - Street 1:100 MAPLE VALE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1100
Practice Address - Country:US
Practice Address - Phone:203-997-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical