Provider Demographics
NPI:1720189145
Name:JONES, ROGER C (PHD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1526
Mailing Address - Country:US
Mailing Address - Phone:413-774-2981
Mailing Address - Fax:413-774-2982
Practice Address - Street 1:622 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1526
Practice Address - Country:US
Practice Address - Phone:413-774-2981
Practice Address - Fax:413-774-2982
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W03508Medicare ID - Type Unspecified