Provider Demographics
NPI:1033263074
Name:COVITZ, JOEL DAVID (ORD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DAVID
Last Name:COVITZ
Suffix:
Gender:M
Credentials:ORD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MASON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4006
Mailing Address - Country:US
Mailing Address - Phone:617-232-0030
Mailing Address - Fax:
Practice Address - Street 1:21 MASON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4006
Practice Address - Country:US
Practice Address - Phone:617-232-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1607103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling