Provider Demographics
NPI:1568952810
Name:AMPHLETT, JANET (PSYD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:AMPHLETT
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 1:8 1/2 ASH STREET PL
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4803
Mailing Address - Country:US
Mailing Address - Phone:617-308-5778
Mailing Address - Fax:
Practice Address - Street 1:47 THORNDIKE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1799
Practice Address - Country:US
Practice Address - Phone:617-661-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7691103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist