Provider Demographics
NPI:1093045015
Name:JANSIEWICZ, EVA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:JANSIEWICZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:540 VFW PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1332
Mailing Address - Country:US
Mailing Address - Phone:617-325-0301
Mailing Address - Fax:617-325-6242
Practice Address - Street 1:540 VFW PKWY STE 3
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1332
Practice Address - Country:US
Practice Address - Phone:617-325-0301
Practice Address - Fax:617-325-6242
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9138103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist