Provider Demographics
NPI:1770729527
Name:JAY, MILTON T (EDD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:T
Last Name:JAY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1812
Mailing Address - Country:US
Mailing Address - Phone:617-928-3446
Mailing Address - Fax:617-928-3446
Practice Address - Street 1:211 BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1812
Practice Address - Country:US
Practice Address - Phone:617-928-3446
Practice Address - Fax:617-928-3446
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2764103G00000X, 103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000W02874OtherBLUE CROSS/BLUE SHIELD