Provider Demographics
NPI:1528221793
Name:POWELL, JEAN WINNIFRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:WINNIFRED
Last Name:POWELL
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 1:2779 N MAIN ST
Mailing Address - Street 2:1 REAR
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1521
Mailing Address - Country:US
Mailing Address - Phone:508-673-3133
Mailing Address - Fax:508-916-3742
Practice Address - Street 1:2779 N MAIN ST
Practice Address - Street 2:1 REAR
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1521
Practice Address - Country:US
Practice Address - Phone:508-673-3133
Practice Address - Fax:508-916-3742
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8869103TA0700X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical