Healthcare Provider Details

I. General information

NPI: 1780523324
Provider Name (Legal Business Name): MS. JACQUELINE ROCHA MACHADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 VERNAL ST
EVERETT MA
02149-2336
US

IV. Provider business mailing address

123 VERNAL ST
EVERETT MA
02149-2336
US

V. Phone/Fax

Practice location:
  • Phone: 857-410-4155
  • Fax:
Mailing address:
  • Phone: 857-410-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4SXV83
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: