Provider Demographics
NPI:1467542704
Name:KLARE, JANE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:KLARE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 STEWART TERRACE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3956
Mailing Address - Country:US
Mailing Address - Phone:617-484-7173
Mailing Address - Fax:617-484-2122
Practice Address - Street 1:36 STEWART TERRACE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3956
Practice Address - Country:US
Practice Address - Phone:617-484-7173
Practice Address - Fax:617-484-2122
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041160OtherFALLON
791710OtherTUFTS
W03875OtherBLUE CROSS
MA0500461Medicaid
008952OtherHARVARD PACIFICARE
1041160OtherFALLON