Doctor Name: | DR. JENICE AMY ELY |
NPI Number: | 1467409839 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 6930 |
Business Practice Address: | 4 Militia Dr Suite 15 Lexington, MA - 024214737 |
Business Phone Number: | 7816741121 |
Business Fax Number: | 7816741121 |
Mailing Address: | 23 Fair Oaks Ter, LEXINGTON |
State: | MA |
Postal Code: | 024216905 |
Phone Number: | 7818639518 |
Fax Number: | 7816741121 |
NPI Enumeration Date: | 05/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 6930 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |