Provider Demographics
NPI:1982703799
Name:TWITCHELL, JACQUELINE ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANNE
Last Name:TWITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:ANNE
Other - Last Name:TWITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:15 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2806
Mailing Address - Country:US
Mailing Address - Phone:239-770-4255
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 321W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:239-770-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
RIPS01294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist