Provider Demographics
NPI:1922164508
Name:SLAVIN, JONATHAN H
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
Last Name:SLAVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:SLAVIN.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, ABBP, PC
Mailing Address - Street 1:1234 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1829
Mailing Address - Country:US
Mailing Address - Phone:617-527-6972
Mailing Address - Fax:
Practice Address - Street 1:1234 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1829
Practice Address - Country:US
Practice Address - Phone:617-527-6972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA801103TH0100X, 103TP0814X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical