Healthcare Provider Details

I. General information

NPI: 1962012807
Provider Name (Legal Business Name): JESSICA MARIE MCQUADE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE MCCARRICK

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W BROAD ST
STAMFORD CT
06902-3713
US

IV. Provider business mailing address

103 W BROAD ST
STAMFORD CT
06902-3713
US

V. Phone/Fax

Practice location:
  • Phone: 203-324-6127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5265
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: