Provider Demographics
NPI:1205022563
Name:HALL, JONATHAN PATRICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PATRICK
Last Name:HALL
Suffix:
Gender:M
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01936-0303
Mailing Address - Country:US
Mailing Address - Phone:978-578-0435
Mailing Address - Fax:978-626-0031
Practice Address - Street 1:136 GARDNER STREET
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01936
Practice Address - Country:US
Practice Address - Phone:978-969-3744
Practice Address - Fax:978-626-0031
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical