Provider Demographics
NPI:1952545089
Name:CECCHETTI, JENNIFER ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:CECCHETTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NORTH RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1037
Mailing Address - Country:US
Mailing Address - Phone:781-275-1684
Mailing Address - Fax:781-275-1611
Practice Address - Street 1:41 NORTH RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1037
Practice Address - Country:US
Practice Address - Phone:781-275-1684
Practice Address - Fax:781-275-1611
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9002103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent