Provider Demographics
NPI:1215984448
Name:PAYSON, JACK M (MA)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:M
Last Name:PAYSON
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CLARIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-962-9050
Mailing Address - Fax:215-752-6172
Practice Address - Street 1:3001 CLARIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-962-9050
Practice Address - Fax:215-752-6172
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002134L101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health