Healthcare Provider Details

I. General information

NPI: 1295771038
Provider Name (Legal Business Name): JASON M SCHMOTZER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WATER ST STE 400
BOSTON MA
02109-4211
US

IV. Provider business mailing address

112 WATER ST STE 400
BOSTON MA
02109-4211
US

V. Phone/Fax

Practice location:
  • Phone: 617-315-8856
  • Fax:
Mailing address:
  • Phone: 617-315-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11453
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0134153
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: