Individual
MR. JEB THOMAS FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1 ARNOLD CIR STE 7, CAMBRIDGE, MA 02139-2250
(617) 444-9513
Mailing address
21 BARTLETT CRES # 1, BROOKLINE, MA 02446-2208
(617) 444-9513
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
10122
MA
103TC1900X
Counseling Psychologist
10122
MA
103TP0814X
Psychoanalysis Psychologist
Primary
10122
MA
Other
Enumeration date
06/08/2009
Last updated
12/04/2015
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