Provider Demographics
NPI:1235212747
Name:LAWSON, JASPER JONES JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASPER
Middle Name:JONES
Last Name:LAWSON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 THORNDIKE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2718
Mailing Address - Country:US
Mailing Address - Phone:617-776-7129
Mailing Address - Fax:617-776-7129
Practice Address - Street 1:9 ACTON RD
Practice Address - Street 2:SUITE 24
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3498
Practice Address - Country:US
Practice Address - Phone:978-256-2250
Practice Address - Fax:617-776-7129
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0512737Medicaid
MAW03101Medicare ID - Type UnspecifiedMEDICARE