Healthcare Provider Details

I. General information

NPI: 1598109639
Provider Name (Legal Business Name): JENNIFER MARIE DORAN PH.D..
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 POST RD
FAIRFIELD CT
06824-5916
US

IV. Provider business mailing address

2160 KINGS HWY UNIT 4
FAIRFIELD CT
06824-6158
US

V. Phone/Fax

Practice location:
  • Phone: 203-208-9856
  • Fax:
Mailing address:
  • Phone: 973-945-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number004537
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: