Healthcare Provider Details

I. General information

NPI: 1306293675
Provider Name (Legal Business Name): RYAN JANE JACOBY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

IV. Provider business mailing address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-5600
  • Fax:
Mailing address:
  • Phone: 617-724-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10981
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: