Provider Demographics
NPI:1205994563
Name:JENSEN, KATHRYN LEONE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LEONE
Last Name:JENSEN
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 1:150 NORTH ST
Mailing Address - Street 2:STE. 39D
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5173
Mailing Address - Country:US
Mailing Address - Phone:413-499-9994
Mailing Address - Fax:413-499-5994
Practice Address - Street 1:150 NORTH ST
Practice Address - Street 2:STE 39D
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5173
Practice Address - Country:US
Practice Address - Phone:413-499-9994
Practice Address - Fax:413-499-5994
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12768300OtherMAGELLAN
141200OtherTUFTS
367586OtherMVP
12768300OtherMAGELLAN