Provider Demographics
NPI:1336632546
Name:FOOTE, JEFFREY P (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:FOOTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01230-9744
Mailing Address - Country:US
Mailing Address - Phone:413-429-9291
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN ST # 24
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1608
Practice Address - Country:US
Practice Address - Phone:917-509-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0107231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical