Provider Demographics
NPI:1801132337
Name:JASON OPPENHEIM, PSYD
Entity type:Organization
Organization Name:JASON OPPENHEIM, PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:OPPENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-863-0747
Mailing Address - Street 1:PO BOX 382409
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-2409
Mailing Address - Country:US
Mailing Address - Phone:617-863-0747
Mailing Address - Fax:
Practice Address - Street 1:22 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-863-0747
Practice Address - Fax:617-860-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty