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General NPI Number Information
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NPI Number | 1467707372
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Entity Type | Individual
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Provider Name | BETH JERSKEY PHD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 54 SKYLINE DR
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City | WESTWOOD
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State | MA
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Zip | 02090-1070
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Country | US
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Telephone | 781-255-5597
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Fax |
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Provider Business Mailing Address
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Address Line | 54 SKYLINE DRIVE
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City | WESTWOOD
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State | MA
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Zip | 02090
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Country | US
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Telephone | 781-234-5679
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS01156
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 10163
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License Number State | MA
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