Jacqueline Guajardo, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002876 Issued in CT

Practice address

99 Woodland St
Hartford, CT 06105-1207

Phone

(860) 714-4212

Fax

(860) 714-8080

NPI assigned

Jan 19, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Asylum Hill Family Medicine Center, Inc.Group PAC ID 9032016134, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jguajardo2388168@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Asylum Hill Family Medicine Center Inc

  dba Family Medicine Center at Asylum Hill

  • Family Medicine Physician
  • Hartford, CT
  • NPI 1083660096

  Clinical

  Medicare reassignment Care Compare group NPD
• Knapp Street Psychiatry, PC

  • Clinical Psychologist
  • Brooklyn, NY
  • NPI 1043248776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1437454717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051207",
            "telephone_number": "860-714-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051207",
            "telephone_number": "860-714-4212",
            "fax_number": "860-714-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUAJARDO",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-19",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002876",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "7187181",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jguajardo155896@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Asylum Hill Family Medicine Center Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "99 Woodland St",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061051207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Juliet Grover, PA-C
• Nancy Grover, MD
• Prashant Grover, M.D.
• Growth and Grace LLC
• Tawana Guadarrama
• Lila Kelly Guarco, PA-C
• Andrea Plummer Guardenier, MD
• Jessica Guarnieri, BS, RDH
• Scott A Guay, LADC, NCGCII
• Elizabeth T. Guerin, PA

• Clinical Psychologist in Hartford, CT
• Providers in Hartford, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.