Healthcare Provider Details

I. General information

NPI: 1922589134
Provider Name (Legal Business Name): MS. JEAN MARIE BARRILE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 08/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PATTON RD
DEVENS MA
01434-4401
US

IV. Provider business mailing address

16 PINEBROOK RD
NASHUA NH
03062-2240
US

V. Phone/Fax

Practice location:
  • Phone: 978-615-5252
  • Fax:
Mailing address:
  • Phone: 603-860-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110700
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: