Provider Demographics
NPI:1124154257
Name:FRANK, JILLIAN BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:BETH
Last Name:FRANK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:BETH
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1330 BEACON ST
Mailing Address - Street 2:SUITE 252
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3282
Mailing Address - Country:US
Mailing Address - Phone:617-966-1476
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST
Practice Address - Street 2:SUITE 252
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3282
Practice Address - Country:US
Practice Address - Phone:617-731-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27-0074694OtherEMPLOYEE IDENTIFI. NUMBER
MAW05941OtherBCBS PROVIDER NUMBER
MA27-0074694OtherEMPLOYEE IDENTIFI. NUMBER