Provider Demographics
NPI:1467707372
Name:JERSKEY, BETH (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:JERSKEY
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 1:54 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090
Mailing Address - Country:US
Mailing Address - Phone:781-234-5679
Mailing Address - Fax:
Practice Address - Street 1:54 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1070
Practice Address - Country:US
Practice Address - Phone:781-255-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01156103T00000X
MA10163103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist