Provider Demographics
NPI:1427122688
Name:GERMAIN, JACQUES (MD)
Entity type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:GERMAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 STEEP HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-1822
Mailing Address - Country:US
Mailing Address - Phone:203-222-9309
Mailing Address - Fax:
Practice Address - Street 1:47 LONG LOTS ROAD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3800
Practice Address - Country:US
Practice Address - Phone:203-221-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0218202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTAG9084409OtherDEA
CTAG9084409OtherDEA