Provider Demographics
NPI:1033872437
Name:SONG, JANE (MA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:JINGLI
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 ESSEX ST # 458A
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2395
Mailing Address - Country:US
Mailing Address - Phone:415-582-7583
Mailing Address - Fax:
Practice Address - Street 1:900 CUMMINGS CTR STE 408U
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6177
Practice Address - Country:US
Practice Address - Phone:978-473-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health