Provider Demographics
NPI:1528558434
Name:GREENWALD O'BRIEN, JESSICA PAIGE (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAIGE
Last Name:GREENWALD O'BRIEN
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-0001
Mailing Address - Country:US
Mailing Address - Phone:617-710-8149
Mailing Address - Fax:508-647-0232
Practice Address - Street 1:10 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4759
Practice Address - Country:US
Practice Address - Phone:617-710-8140
Practice Address - Fax:508-647-1954
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6814103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic