Provider Demographics
NPI:1659582138
Name:FLETCHER, JOHN DOUGLAS (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 WASHINGTON ST
Mailing Address - Street 2:STE 3
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1634
Mailing Address - Country:US
Mailing Address - Phone:617-782-6460
Mailing Address - Fax:617-782-6457
Practice Address - Street 1:56 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1322
Practice Address - Country:US
Practice Address - Phone:617-782-6460
Practice Address - Fax:617-782-6457
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101Y00000XBehavioral Health & Social Service ProvidersCounselor