Healthcare Provider Details

I. General information

NPI: 1881801702
Provider Name (Legal Business Name): JENNIFER A DOTSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 BEACON ST # 204
BOSTON MA
02215-3033
US

IV. Provider business mailing address

896 BEACON ST # 204
BOSTON MA
02215-3033
US

V. Phone/Fax

Practice location:
  • Phone: 617-447-0378
  • Fax: 617-701-7674
Mailing address:
  • Phone: 617-447-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9348
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: