Provider Demographics
NPI:1386869568
Name:BABINSKY, JERI D (DMIN)
Entity type:Individual
Prefix:DR
First Name:JERI
Middle Name:D
Last Name:BABINSKY
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W MAIN ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2132
Mailing Address - Country:US
Mailing Address - Phone:508-366-7707
Mailing Address - Fax:508-393-0026
Practice Address - Street 1:300 W MAIN ST
Practice Address - Street 2:BLDG A
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2132
Practice Address - Country:US
Practice Address - Phone:508-366-7707
Practice Address - Fax:508-393-0026
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3023103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BAW03604Medicare UPIN