Healthcare Provider Details

I. General information

NPI: 1750378469
Provider Name (Legal Business Name): JESSICA L GOREN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST WHIDDEN HOSPITAL
EVERETT MA
02149-5066
US

IV. Provider business mailing address

1035 CAMBRIDGE ST PHARMACY ADMIN 2ND FLOOR
CAMBRIDGE MA
02141-1057
US

V. Phone/Fax

Practice location:
  • Phone: 617-806-8514
  • Fax:
Mailing address:
  • Phone: 617-806-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number25120
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: