Provider Demographics
NPI:1508132630
Name:GAYNOR, JODYAN K (MA)
Entity Type:Individual
Prefix:
First Name:JODYAN
Middle Name:K
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 FARMINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2184
Mailing Address - Country:US
Mailing Address - Phone:860-592-1030
Mailing Address - Fax:888-772-1877
Practice Address - Street 1:998 FARMINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2184
Practice Address - Country:US
Practice Address - Phone:860-592-1030
Practice Address - Fax:888-772-1877
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135631101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health