Provider Demographics
NPI:1336241843
Name:AXELROD, JANE (EDD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:AXELROD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5008
Mailing Address - Country:US
Mailing Address - Phone:978-474-9214
Mailing Address - Fax:978-474-9214
Practice Address - Street 1:661 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5000
Practice Address - Country:US
Practice Address - Phone:978-886-1115
Practice Address - Fax:978-474-9214
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA346294OtherMHN
MA2196819OtherCIGNA BEHAVIORAL HEALTH
MA682896OtherTUFTS HEALTH PLAN
MA9371178OtherPRIVATE HEALTHCARE SYSTEM
MALM1163OtherBLUE CROSS BLUE SHIELD OF