Provider Demographics
NPI:1972542769
Name:LEBOVIDGE, JENNIFER SORIANO (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SORIANO
Last Name:LEBOVIDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BEDFORD ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4646
Mailing Address - Country:US
Mailing Address - Phone:781-861-6655
Mailing Address - Fax:
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 12
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-861-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical