Provider Demographics
NPI:1689787251
Name:WEBB, JONICE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONICE
Middle Name:M
Last Name:WEBB
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 1:3R WALLIS CT
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:781-652-0162
Mailing Address - Fax:781-652-0162
Practice Address - Street 1:3R WALLIS CT
Practice Address - Street 2:SUITE 5
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421
Practice Address - Country:US
Practice Address - Phone:781-652-0162
Practice Address - Fax:781-652-0162
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04863Medicare ID - Type UnspecifiedPROVIDER I.D.