Provider Demographics
NPI:1962540476
Name:GALIN, JODI R (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:R
Last Name:GALIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4945
Mailing Address - Country:US
Mailing Address - Phone:781-861-1211
Mailing Address - Fax:
Practice Address - Street 1:5 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4945
Practice Address - Country:US
Practice Address - Phone:781-861-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7073103TC0700X
NY012528-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7414124OtherAETNA PROVIDER ID NUMBER
MAW05563OtherBCBS ID NUMBER