Active NPI
Jacquelyn Bertrand, PHD
- Clinical Psychologist
- Atlanta, GA
National Provider Identifier
1710068051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY002001
- Practice address
- 1920 Briarcliff Rd NE
Atlanta, GA 30329-4010 - Phone
- (404) 419-4000
- Fax
- (404) 419-4505
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY002001 | GA | Primary |
Addresses
Primary practice location
1920 Briarcliff Rd NE
Atlanta, GA 30329-4010
Mailing address
2931 E Biddle St
Patient Accounting
Baltimore, MD 21213-3939
Phone (443) 923-1886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY002001 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710068051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2931 E BIDDLE ST",
"address_2": "PATIENT ACCOUNTING",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212133939",
"telephone_number": "443-923-1886",
"fax_number": "443-923-1875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 BRIARCLIFF RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303294010",
"telephone_number": "404-419-4000",
"fax_number": "404-419-4505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTRAND",
"first_name": "JACQUELYN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY002001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.