Healthcare Provider Details

I. General information

NPI: 1184873721
Provider Name (Legal Business Name): JESSICA DANIELLE BIREN CAVERLY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 10/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLD NEW MILFORD RD 1E
BROOKFIELD CT
06804-2426
US

IV. Provider business mailing address

2 OLD NEW MILFORD RD 1E
BROOKFIELD CT
06804-2647
US

V. Phone/Fax

Practice location:
  • Phone: 203-885-0500
  • Fax: 203-702-5345
Mailing address:
  • Phone: 203-885-0500
  • Fax: 203-702-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9367
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3248
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3248
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3248
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3248
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3248
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3248
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3248
License Number StateCT
# 9
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number3248
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: