Provider Demographics
NPI:1093821266
Name:WOOD, JENNIFER ROBIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROBIN
Last Name:WOOD
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 1:66 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2212
Mailing Address - Country:US
Mailing Address - Phone:206-229-0680
Mailing Address - Fax:
Practice Address - Street 1:66 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2212
Practice Address - Country:US
Practice Address - Phone:206-229-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical