Healthcare Provider Details

I. General information

NPI: 1174984827
Provider Name (Legal Business Name): JENNA MEZIN SCHMID PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA MARIE MEZIN PSYD

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MT AUBURN ST 4 EAST HARVARD UNIVERSITY HEALTH SERVICES
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

75 MT AUBURN ST 4 EAST HARVARD UNIVERSITY HEALTH SERVICES
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-495-2042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10208
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: