Provider Demographics
NPI:1144293812
Name:MACDONALD, JANE E (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2551
Mailing Address - Country:US
Mailing Address - Phone:617-965-5615
Mailing Address - Fax:617-964-6369
Practice Address - Street 1:188 PARKER ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2551
Practice Address - Country:US
Practice Address - Phone:617-965-5615
Practice Address - Fax:617-964-6369
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3774103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03835OtherBLUECROSS BLUESHIELD
MA709918OtherTUFTS HEALTH PLAN
MA0521256Medicaid
MA0521256Medicaid