Healthcare Provider Details

I. General information

NPI: 1992874275
Provider Name (Legal Business Name): JEROME J SCHULTZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PRESIDENTS LANDING CCAD 1ST FLOOR
MEDFORD MA
02155
US

IV. Provider business mailing address

1493 CAMBRIDGE ST CCAD STATION LANDING
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-8653
  • Fax: 781-306-8646
Mailing address:
  • Phone: 781-306-8653
  • Fax: 781-306-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2058
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: