Provider Demographics
NPI:1952312860
Name:JABLON, MICHAEL ALAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:JABLON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460
Mailing Address - Country:US
Mailing Address - Phone:617-527-4475
Mailing Address - Fax:
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:STE 13
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-749-4600
Practice Address - Fax:781-741-8341
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA330230OtherHARVARD PILGRIM HEALTH CA
MA728655OtherTUFTS HEALTH PLAN
MAW04272OtherBCBS
MA04343088003OtherPACIFICARE BEHAVIORAL HEA
MA4122160OtherAETNA
MA4122160OtherAETNA