=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871814038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE CHRISTINE BJERG PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 09/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 WASHINGTON ST
-----------------------------------------------------
City | SOMERVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02143-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-547-2255
-----------------------------------------------------
Fax | 617-547-0003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 269 WASHINGTON ST
-----------------------------------------------------
City | SOMERVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02143-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-547-2255
-----------------------------------------------------
Fax | 617-547-0003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 10373
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------