Provider Demographics
NPI:1215982053
Name:JETTE, CARMEN C BRENES (PHD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:C BRENES
Last Name:JETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BEACON ST STE 255
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3200
Mailing Address - Country:US
Mailing Address - Phone:781-861-2978
Mailing Address - Fax:781-676-7942
Practice Address - Street 1:1330 BEACON ST STE 255
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3200
Practice Address - Country:US
Practice Address - Phone:781-861-2978
Practice Address - Fax:781-676-7942
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA669495OtherTUFTS THRU HVMA
MAJEW04565OtherBLUE CROSS
MA5690762OtherAETNA
MA255317000OtherMAGELLAN BEHAVIOR HEALTH
MA729686OtherTUFTS
MA0523259OtherMBHP
MA0033463OtherNEIGHBORHOOD HEALTH PLAN
MA195306OtherMHN