Provider Demographics
NPI:1295771038
Name:SCHMOTZER, JASON M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:SCHMOTZER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 COMMONWEALTH AVE STE U3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2749
Mailing Address - Country:US
Mailing Address - Phone:617-259-1895
Mailing Address - Fax:
Practice Address - Street 1:160 COMMONWEALTH AVE STE U3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2749
Practice Address - Country:US
Practice Address - Phone:617-259-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0134153103TC0700X
FLPY7006103TC0700X
MA11453103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7006OtherSTATE LICENSE
FLP00726450Medicare UPIN
FLU75952Medicare PIN