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NPI Code Detail

MEDICARE: JENA GORDON TALBOT PHD

MEDICARE: JENA GORDON TALBOT 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 PsychologistPSY10000133MA
2103TC0700XClinical PsychologistPS02249RI

General Provider Information

NPI Number : 1821511338
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENA GORDON TALBOT PHD
Provider Business Mailing Address
First Line : 31 CURVE ST
Second Line :
City : WEST NEWTON
State : MA
Zip : 02465-2206
Country : US
Telephone Number : 617-893-2440
Fax Number :
Provider Business Practice Location Address
First Line : 1501 WASHINGTON ST
Second Line :
City : BRAINTREE
State : MA
Zip : 02184-7599
Country : US
Telephone Number : 508-747-7051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2017
Last Update Date : 03/18/2024

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