Provider Demographics
NPI:1154587962
Name:JENKINS, YVONNE MARIE (PHD)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 BEACON ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4816
Mailing Address - Country:US
Mailing Address - Phone:617-739-0090
Mailing Address - Fax:
Practice Address - Street 1:1415 BEACON ST
Practice Address - Street 2:SUITE 222
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4816
Practice Address - Country:US
Practice Address - Phone:617-739-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJE-WO3211Medicare PIN