Individual
DR. DORIS A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6 BIGELOW STREET, CAMBRIDGE, MA 02139-2384
(617) 547-0457
Mailing address
6 BIGELOW STREET, CAMBRIDGE, MA 02139
(617) 547-0457
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6213
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W04965
BLUE CROSS PROVIDER NUMBE
MA
Enumeration date
06/13/2007
Last updated
07/08/2007
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