Healthcare Provider Details

I. General information

NPI: 1538197199
Provider Name (Legal Business Name): JO ELLEN BOSKIND M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MECHANIC ST MEDICAL ARTS BUILDING
ATHOL MA
01331-3534
US

IV. Provider business mailing address

80 MECHANIC ST MEDICAL ARTS BUILDING
ATHOL MA
01331-3534
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-0929
  • Fax: 978-249-5323
Mailing address:
  • Phone: 978-249-0929
  • Fax: 978-249-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101649
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: