Provider Demographics
NPI:1255451134
Name:BEAN, JESSICA LORD (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LORD
Last Name:BEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:366 ASH SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3504
Mailing Address - Country:US
Mailing Address - Phone:860-729-3963
Mailing Address - Fax:860-633-8176
Practice Address - Street 1:300 HEBRON AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2176
Practice Address - Country:US
Practice Address - Phone:860-633-8155
Practice Address - Fax:860-633-8176
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT2864103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent