Individual
JILL SUZANNE DAMON-MINOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-2756
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
8957
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0587052
—
MA
Enumeration date
12/18/2008
Last updated
10/07/2009
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