Provider Demographics
NPI:1508856246
Name:BUCHIN, JACQUELINE CHASE (PSYD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CHASE
Last Name:BUCHIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 7W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-738-4814
Mailing Address - Fax:617-278-9040
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE 7W
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-738-4814
Practice Address - Fax:617-278-9040
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMHMA0523011Medicaid
725288OtherTUFTS
MAW05063Medicare ID - Type Unspecified