Healthcare Provider Details

I. General information

NPI: 1093874323
Provider Name (Legal Business Name): JAYLEEN HARLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE BOSTON VAMC
BOSTON MA
02130-4817
US

IV. Provider business mailing address

9 KIMBALL CT APT 1006
BURLINGTON MA
01803-3871
US

V. Phone/Fax

Practice location:
  • Phone: 617-555-1212
  • Fax:
Mailing address:
  • Phone: 203-506-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number153836
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number153836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: