Healthcare Provider Details

I. General information

NPI: 1952848061
Provider Name (Legal Business Name): DAVID PAUL JENKINS III PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WAVERLEY ST
FRAMINGHAM MA
01702-7079
US

IV. Provider business mailing address

354 WAVERLEY ST
FRAMINGHAM MA
01702-7079
US

V. Phone/Fax

Practice location:
  • Phone: 508-661-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10000931
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: