MEDICARE: AMANDA K JABLONSKI MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295895001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA K JABLONSKI MA

Provider Business Mailing Address
First Line	:	1115 W CHESTNUT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7501
Country	:	US
Telephone Number	:	508-580-4691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 W CHESTNUT ST
Second Line	:	SOUTH BAY MENTAL HEALTH
City	:	BROCKTON
State	:	MA
Zip	:	02301-7501
Country	:	US
Telephone Number	:	508-580-4691
Fax Number	:	508-588-5751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	12/12/2011

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