=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740091164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EIPPER-MAINS PSYCHIATRIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 BEDFORD ST STE 230
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02420-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-226-2959
-----------------------------------------------------
Fax | 570-243-0810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 OVERLOOK DR
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01730-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-874-7994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. JODI ELENE EIPPER-MAINS
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 781-226-2959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------