Provider Demographics
NPI:1053632174
Name:MEYER, JESSICA (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MEYER
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 1:300 PLAZA MIDDLESEX
Mailing Address - Street 2:ROEDER & POLANSKY FAMILY ASSOCIATION
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PLAZA MIDDLESEX
Practice Address - Street 2:ROEDER & POLANSKY FAMILY ASSOCIATION
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3455
Practice Address - Country:US
Practice Address - Phone:860-347-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist