Provider Demographics
NPI:1689795999
Name:KRITZMAN, JANIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANIE
Middle Name:L
Last Name:KRITZMAN
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 1:24 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2003
Mailing Address - Country:US
Mailing Address - Phone:781-393-8889
Mailing Address - Fax:781-396-3948
Practice Address - Street 1:92 HIGH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3850
Practice Address - Country:US
Practice Address - Phone:781-393-8889
Practice Address - Fax:781-306-3948
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW5071Medicare ID - Type Unspecified