Healthcare Provider Details

I. General information

NPI: 1558259234
Provider Name (Legal Business Name): JAKOB BAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BLUE BAIR

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SCOTTFIELD RD APT 6
BOSTON MA
02134-3710
US

IV. Provider business mailing address

11 SCOTTFIELD RD APT 6
BOSTON MA
02134-3710
US

V. Phone/Fax

Practice location:
  • Phone: 603-892-4563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: