Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 11160 | MA |
Y | 103G00000X | Clinical Psychologist | 11160 | MA |
Y | 103TC0700X | Clinical Psychologist | 11160 | MA |
NPI | 1174085278 |
---|---|
Provider Name | Dr. Jonathan Edward Chester |
First Address | Somerville, MA 02145-1931 |
Second Address | Boston, MA 02116-4710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 09/02/2021 |