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NPI Code Detail

MEDICARE: DR. JESSICA PERRY PSY.D.

MEDICARE: DR. JESSICA PERRY PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist9569MA

General Provider Information

NPI Number : 1073839213
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA PERRY PSY.D.
Provider Business Mailing Address
First Line : 115 MAIN ST STE 2D
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1469
Country : US
Telephone Number : 508-238-7766
Fax Number : 508-230-5089
Provider Business Practice Location Address
First Line : 115 MAIN ST STE 2D
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1469
Country : US
Telephone Number : 508-238-7766
Fax Number : 508-230-5089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2010
Last Update Date : 09/10/2012

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