Provider Demographics
NPI:1750301925
Name:BALLEW, JENNIFER R (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:BALLEW
Suffix:
Gender:F
Credentials:DO, PHD
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Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC-CVO
Mailing Address - City:WHETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-5507
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5285
Practice Address - Fax:860-224-5734
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0426262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400008881Medicare PIN