Provider Demographics
NPI:1790004240
Name:DRAYER, JEFFREY DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:DRAYER
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 1:555 WASHINGTON ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5996
Mailing Address - Country:US
Mailing Address - Phone:781-237-1735
Mailing Address - Fax:781-237-1768
Practice Address - Street 1:555 WASHINGTON ST
Practice Address - Street 2:SUITE #5
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5996
Practice Address - Country:US
Practice Address - Phone:781-237-1735
Practice Address - Fax:781-237-1768
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9184103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical