Provider Demographics
NPI:1538230743
Name:ANDERSON, JANIS L (PHD)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:240 ARBORWAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3502
Mailing Address - Country:US
Mailing Address - Phone:617-732-7993
Mailing Address - Fax:617-738-8703
Practice Address - Street 1:221 LONGWOOD AVE
Practice Address - Street 2:BWH PSYCHIATRY MEZZ.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-732-7993
Practice Address - Fax:617-738-8703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical