1174984827 NPI number — DR. JENNA MEZIN SCHMID PSYD

Table of content: DR. JENNA MEZIN SCHMID PSYD (NPI 1174984827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174984827 NPI number — DR. JENNA MEZIN SCHMID PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMID
Provider First Name:
JENNA
Provider Middle Name:
MEZIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEZIN
Provider Other First Name:
JENNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174984827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 MT AUBURN ST 4 EAST
Provider Second Line Business Mailing Address:
HARVARD UNIVERSITY HEALTH SERVICES
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 MT AUBURN ST 4 EAST
Provider Second Line Business Practice Location Address:
HARVARD UNIVERSITY HEALTH SERVICES
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-495-2042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  10208 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)