Healthcare Provider Details

I. General information

NPI: 1871814038
Provider Name (Legal Business Name): ANNE CHRISTINE BJERG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 WASHINGTON ST
SOMERVILLE MA
02143-3301
US

IV. Provider business mailing address

269 WASHINGTON ST
SOMERVILLE MA
02143-3301
US

V. Phone/Fax

Practice location:
  • Phone: 617-547-2255
  • Fax: 617-547-0003
Mailing address:
  • Phone: 617-547-2255
  • Fax: 617-547-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10373
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: