Provider Demographics
NPI:1992874275
Name:SCHULTZ, JEROME J (PHD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:J
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:CCAD STATION LANDING
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:781-306-8653
Mailing Address - Fax:781-306-8646
Practice Address - Street 1:101 PRESIDENTS LANDING
Practice Address - Street 2:CCAD 1ST FLOOR
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-306-8653
Practice Address - Fax:781-306-8646
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2058103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist