Provider Demographics
NPI:1184873721
Name:BIREN CAVERLY, JESSICA DANIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DANIELLE
Last Name:BIREN CAVERLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:2 OLD NEW MILFORD RD
Mailing Address - Street 2:1E
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-885-0500
Mailing Address - Fax:203-702-5345
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:1E
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-885-0500
Practice Address - Fax:203-702-5345
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA9367103TC0700X
CT3248103G00000X, 103T00000X, 103TC0700X, 103TC2200X, 103TB0200X, 103TF0200X, 103TM1800X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth