Individual
JENESSE KAITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 SPRINGS RD, BEDFORD, MA 01730-1114
(781) 687-2000
Mailing address
200 SPRINGS RD, BEDFORD, MA 01730-1114
(781) 687-2000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11491
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
09/21/2015
Last updated
05/12/2021
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