Provider Demographics
NPI:1689780702
Name:JENKINS, DONNA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:F
Last Name:JENKINS
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 1:9 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-2030
Mailing Address - Country:US
Mailing Address - Phone:978-374-1351
Mailing Address - Fax:781-224-9632
Practice Address - Street 1:599 NORTH AVE
Practice Address - Street 2:DOOR 8
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1648
Practice Address - Country:US
Practice Address - Phone:781-224-9884
Practice Address - Fax:781-224-9632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0522279Medicaid
MA0522279Medicaid