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General NPI Number Information
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NPI Number | 1225216518
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Entity Type | Individual
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Provider Name | JASON M FOGLER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 300 LONGWOOD AVE FEGAN 10
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City | BOSTON
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State | MA
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Zip | 02115-5724
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Country | US
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Telephone | 617-355-6455
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Fax |
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Provider Business Mailing Address
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Address Line | 34 BURNSIDE RD
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City | NEEDHAM
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State | MA
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Zip | 02494-1949
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Country | US
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Telephone | 781-444-2052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1184
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License Number State | NH
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