Healthcare Provider Details

I. General information

NPI: 1154531101
Provider Name (Legal Business Name): JANA P. CHICKINSKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 MAIN ST SUITE 3
WHITINSVILLE MA
01588-1712
US

IV. Provider business mailing address

334 PROVIDENCE RD
SOUTH GRAFTON MA
01560-1335
US

V. Phone/Fax

Practice location:
  • Phone: 774-551-6546
  • Fax:
Mailing address:
  • Phone: 508-839-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6881
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6881
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6881
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6881
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number6881
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6881
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: