Provider Demographics
NPI:1144205741
Name:MCCUTCHEN, AILA JESSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AILA JESSE
Middle Name:
Last Name:MCCUTCHEN
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 1:93 UNION ST
Mailing Address - Street 2:SUITE 303C
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2244
Mailing Address - Country:US
Mailing Address - Phone:617-527-3041
Mailing Address - Fax:
Practice Address - Street 1:93 UNION STREET
Practice Address - Street 2:SUITE 320 THE CENTER FOR COGNITIVE THERAPY
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-527-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4956103T00000X
SC987103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04740OtherBCBS MA
MA0500623Medicaid
MA0500623Medicaid