Provider Demographics
NPI:1265500508
Name:DREEBEN, JANE (PHD, LADC I)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:DREEBEN
Suffix:
Gender:F
Credentials:PHD, LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-0516
Mailing Address - Country:US
Mailing Address - Phone:508-693-5523
Mailing Address - Fax:508-696-8619
Practice Address - Street 1:15 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-5523
Practice Address - Fax:508-696-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6648103T00000X
MA415103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05885OtherBLUE CROSS BLUE SHIELD
MAW51018Medicare ID - Type Unspecified