Provider Demographics
NPI:1083884340
Name:SCHWALBACH, JEANNE M
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:M
Last Name:SCHWALBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BOSTON AVE
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4243
Mailing Address - Country:US
Mailing Address - Phone:781-306-1180
Mailing Address - Fax:781-306-1190
Practice Address - Street 1:200 BOSTON AVE
Practice Address - Street 2:SUITE 1900
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4243
Practice Address - Country:US
Practice Address - Phone:781-306-1180
Practice Address - Fax:781-306-1190
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1625101YM0800X
MA901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health