Provider Demographics
NPI:1851549539
Name:OPPENHEIM, JASON P (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:OPPENHEIM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382409
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-2409
Mailing Address - Country:US
Mailing Address - Phone:617-863-0747
Mailing Address - Fax:
Practice Address - Street 1:22 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-863-0747
Practice Address - Fax:617-860-2287
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1274103TC0700X
MA11127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical