Provider Demographics
NPI:1093866949
Name:PECCHENINO, JESSICA IRENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:IRENE
Last Name:PECCHENINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STRAWBERRY HILL RD
Mailing Address - Street 2:LEVEL 2
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5757
Mailing Address - Country:US
Mailing Address - Phone:978-264-2952
Mailing Address - Fax:
Practice Address - Street 1:4 STRAWBERRY HILL RD
Practice Address - Street 2:LEVEL 2
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5757
Practice Address - Country:US
Practice Address - Phone:978-264-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPE W51393Medicare ID - Type UnspecifiedMEDICARE