Provider Demographics
NPI:1205004819
Name:JARETT, LAURA R (PH D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:JARETT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 RIVER EDGE FARMS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2756
Mailing Address - Country:US
Mailing Address - Phone:203-245-8888
Mailing Address - Fax:
Practice Address - Street 1:88 RIVER EDGE FARMS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2756
Practice Address - Country:US
Practice Address - Phone:203-245-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical