Provider Demographics
NPI:1831686252
Name:GEORGE, JANET LYNN (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7907
Mailing Address - Country:US
Mailing Address - Phone:781-646-6733
Mailing Address - Fax:
Practice Address - Street 1:500 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2439
Practice Address - Country:US
Practice Address - Phone:617-624-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3675103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent