Healthcare Provider Details

I. General information

NPI: 1265500508
Provider Name (Legal Business Name): JANE DREEBEN PH.D., L.A.D.C. I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CHURCH ST.
VINEYARD HAVEN MA
02568
US

IV. Provider business mailing address

PO BOX 516
WEST TISBURY MA
02575-0516
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-5523
  • Fax: 508-696-8619
Mailing address:
  • Phone: 508-693-5523
  • Fax: 508-696-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6648
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number415
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: