Provider Demographics
NPI:1487010799
Name:MENTAL FITNESS AND PSYCHOTHERAPY
Entity Type:Organization
Organization Name:MENTAL FITNESS AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HAYWOOD
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-419-0643
Mailing Address - Street 1:108 FULTON ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1422
Mailing Address - Country:US
Mailing Address - Phone:508-241-2878
Mailing Address - Fax:
Practice Address - Street 1:1318 BEACON ST
Practice Address - Street 2:SUITE 9
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3704
Practice Address - Country:US
Practice Address - Phone:617-419-0643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty