Provider Demographics
NPI:1427121433
Name:BEATMAN, JAY ROGERS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROGERS
Last Name:BEATMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W AVON RD
Mailing Address - Street 2:STE 302
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3679
Mailing Address - Country:US
Mailing Address - Phone:860-810-0425
Mailing Address - Fax:860-404-0870
Practice Address - Street 1:46 W AVON RD
Practice Address - Street 2:STE 302
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3679
Practice Address - Country:US
Practice Address - Phone:860-810-0425
Practice Address - Fax:860-404-0870
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004208048Medicaid