Provider Demographics
NPI:1396885703
Name:KESHET, JAMIE K (ED E)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:K
Last Name:KESHET
Suffix:
Gender:F
Credentials:ED E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CONSTITUTION LN
Mailing Address - Street 2:SUITE 3C1
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:978-777-1119
Mailing Address - Fax:
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:SUITE 3C1
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-777-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6093103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04984Medicare ID - Type Unspecified