Healthcare Provider Details

I. General information

NPI: 1174085278
Provider Name (Legal Business Name): JONATHAN EDWARD CHESTER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 02/09/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 TREMONT ST
BOSTON MA
02116-4710
US

IV. Provider business mailing address

48 JAQUES ST APT 2
SOMERVILLE MA
02145-1931
US

V. Phone/Fax

Practice location:
  • Phone: 617-824-8595
  • Fax:
Mailing address:
  • Phone: 609-933-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number11160
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11160
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: