Basic Information
| Provider Information | |||||||||
| NPI: | 1598499915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRITT-FRIEDMAN | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 GLEN TER | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069061401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189741752 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1445 E PUTNAM AVE | ||||||||
| Address2: | |||||||||
| City: | OLD GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068701379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036228600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2022 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 017311-1 | NY | N | Behavioral Health & Social Service Providers | Psychologist | 103TC2200X | 017311-1 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC2200X | 003700 | CT | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103T00000X | 003700 | CT | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.