Healthcare Provider Details

I. General information

NPI: 1427121433
Provider Name (Legal Business Name): JAY ROGERS BEATMAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 W AVON RD STE 302
AVON CT
06001-3679
US

IV. Provider business mailing address

46 W AVON RD STE 302
AVON CT
06001-3679
US

V. Phone/Fax

Practice location:
  • Phone: 860-810-0425
  • Fax: 860-404-0870
Mailing address:
  • Phone: 860-810-0425
  • Fax: 860-404-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002304
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: