| Doctor Name: | DR. JEFFREY TWAROG |
| NPI Number: | 1013082239 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D. |
| License Number: | 1852 |
| Business Practice Address: | 109 Roosevelt Rd Cotuit, MA - 026352713 |
| Business Phone Number: | 5084284307 |
| Business Fax Number: | 5084205542 |
| Mailing Address: | 109 Roosevelt Rd, COTUIT |
| State: | MA |
| Postal Code: | 026352713 |
| Phone Number: | 5084284307 |
| Fax Number: | 5084205542 |
| NPI Enumeration Date: | 11/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 1852 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |