Healthcare Provider Details

I. General information

NPI: 1821293549
Provider Name (Legal Business Name): JEFFREY MICHAEL BURDA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 PROSPECT AVE STE 301
HARTFORD CT
06105-4288
US

IV. Provider business mailing address

674 PROSPECT AVE
HARTFORD CT
06105-4288
US

V. Phone/Fax

Practice location:
  • Phone: 860-315-3896
  • Fax:
Mailing address:
  • Phone: 860-315-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3594
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: