Provider Demographics
NPI:1720114804
Name:GAJEE, NANCY K (PH D)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:GAJEE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PARKER HILL AVE
Mailing Address - Street 2:JUDGE BAKER CHILDREN'S CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3225
Mailing Address - Country:US
Mailing Address - Phone:617-278-4254
Mailing Address - Fax:617-278-4139
Practice Address - Street 1:53 PARKER HILL AVE
Practice Address - Street 2:JUDGE BAKER CHILDREN'S CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-3225
Practice Address - Country:US
Practice Address - Phone:617-278-4254
Practice Address - Fax:617-278-4139
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA9857103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312677Medicaid
MA685661OtherTUFTS
MAM18708OtherBLUE CROSS
MAM20807Medicare ID - Type Unspecified