Healthcare Provider Details

I. General information

NPI: 1578443495
Provider Name (Legal Business Name): JONAH KILDON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645R MASSACHUSETTS AVE
ARLINGTON MA
02476-5004
US

IV. Provider business mailing address

226 MASSACHUSETTS AVE STE 2A
ARLINGTON MA
02474-8449
US

V. Phone/Fax

Practice location:
  • Phone: 617-977-4770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10001994
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: