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General NPI Number Information
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NPI Number | 1649558156
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Entity Type | Individual
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Provider Name | JESSICA ELIZABETH MAGNUSSEN
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Gender | Female
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 25 ARABIAN DR
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City | TAUNTON
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State | MA
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Zip | 02780-7182
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Country | US
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Telephone | 508-802-8886
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Fax | 508-880-7698
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Provider Business Mailing Address
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Address Line | 25 ARABIAN DR
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City | TAUNTON
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State | MA
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Zip | 02780-7182
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Country | US
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Telephone | 508-802-8886
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Fax | 508-880-7698
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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 |
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License Number State |
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