Provider Demographics
NPI:1891865606
Name:DRISCOLL, JEANNE WATSON (PHD,APRN,BC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:WATSON
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:PHD,APRN,BC
Other - Prefix:
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Mailing Address - Street 1:5 SCHIRMER RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1112
Mailing Address - Country:US
Mailing Address - Phone:617-325-8940
Mailing Address - Fax:617-327-8570
Practice Address - Street 1:27 MICA LN
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1724
Practice Address - Country:US
Practice Address - Phone:781-431-8861
Practice Address - Fax:617-327-8570
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA111854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0188OtherBCBS OF MA