Provider Demographics
NPI:1861608531
Name:DANDREA, JENNIFER TARA (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TARA
Last Name:DANDREA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-343-0448
Mailing Address - Fax:
Practice Address - Street 1:300 PLAZA MIDDLESEX
Practice Address - Street 2:ROEDER & POLANSKY CHILD & FAMILY ASSOCIATES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-347-9911
Practice Address - Fax:860-347-8120
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist