Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6881 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 6881 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6881 | MA |
Y | 103G00000X | Clinical Psychologist | 6881 | MA |
Y | 103TC0700X | Clinical Psychologist | 6881 | MA |
N | 103TF0000X | Family Psychologist | 6881 | MA |
N | 103TP2701X | Group Psychotherapist | 6881 | MA |
NPI | 1154531101 |
---|---|
Provider Name | Dr. Jana P. Chickinski |
First Address | South Grafton, MA 01560-1335 |
Second Address | Whitinsville, MA 01588-1712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 07/01/2013 |