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NPI Code Detail

MEDICARE: JESSICA ELLEN GOLDSTEIN PHD

MEDICARE: JESSICA ELLEN GOLDSTEIN PHD
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 Psychologist7707MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W05983OTHERMABLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1477542777
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ELLEN GOLDSTEIN PHD
Provider Business Mailing Address
First Line : 115 MILL ST
Second Line :
City : BELMONT
State : MA
Zip : 02478-1041
Country : US
Telephone Number : 617-855-2206
Fax Number : 617-855-3691
Provider Business Practice Location Address
First Line : 115 MILL ST
Second Line :
City : BELMONT
State : MA
Zip : 02478-1041
Country : US
Telephone Number : 617-855-2206
Fax Number : 617-855-3691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 07/08/2007

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