Provider Demographics
NPI:1578647962
Name:BRESCIA, JEANINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:
Last Name:BRESCIA
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 1:11 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3805
Mailing Address - Country:US
Mailing Address - Phone:617-484-4531
Mailing Address - Fax:
Practice Address - Street 1:50 TRAPELO RD STE 4
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4447
Practice Address - Country:US
Practice Address - Phone:617-484-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3085103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03252Medicare ID - Type UnspecifiedPSYCHOTHERAPY