Individual
JASON PETRILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 BROOKLINE AVE, RABB-2, DEPARTMENT OF PSYCHIATRY, BOSTON, MA 02215-5400
(617) 667-9745
Mailing address
330 BROOKLINE AVE, RABB-2, DEPARTMENT OF PSYCHIATRY, BOSTON, MA 02215-5400
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
212534
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212534
TUFTS HEALTH PLAN
MA
01
—
J26361
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/18/2006
Last updated
07/08/2007
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