Provider Demographics
NPI:1851414882
Name:MEYER, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 BEACON ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1930
Mailing Address - Country:US
Mailing Address - Phone:617-974-6500
Mailing Address - Fax:
Practice Address - Street 1:1842 BEACON ST
Practice Address - Street 2:SUITE 402
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1930
Practice Address - Country:US
Practice Address - Phone:617-974-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2101132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry