Jennifer Marie Primack, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS01130 Issued in RI

Practice address

345 Blackstone Blvd
Department of Psychosocial Research
Providence, RI 02906-4800

Phone

(401) 455-6336

NPI assigned

Mar 4, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Marie Lane Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299196800000",
    "number": "1255639910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "address_2": "DEPARTMENT OF PSYCHOSOCIAL RESEARCH",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-455-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "address_2": "DEPARTMENT OF PSYCHOSOCIAL RESEARCH",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-455-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMACK",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-04",
        "last_updated": "2011-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "RI",
            "license": "PS01130",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "LANE",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Catherine Anderson Price, DOCTOR OF ACUPUNCTUR
• Cristofer Malvern Price, PHARM.D, BCPP
• Joshua Price
• Lawrence Howard Price, MD
• Marilyn Price, MD
• Prime Drug Inc
• Anna Prince, LICSW
• Brea Shay Prindaville, M.D.
• Kathleen Mary Pringle, RN
• Ashley Proal, AGACNP-BC

• Clinical Psychologist in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Psychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.