| Doctor Name: | JESSICA ELIZABETH DZYAK |
| NPI Number: | 1043510720 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 7454 |
| Business Practice Address: | 14 Fordham Rd Allston, MA - 021343006 |
| Business Phone Number: | 6177826460 |
| Business Fax Number: | |
| Mailing Address: | 13 Tabor Pl, 2 BROOKLINE |
| State: | MA |
| Postal Code: | 024456924 |
| Phone Number: | 6175191922 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2010 |
| NPI Last Update Date: | 10/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 7454 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |