Healthcare Provider Details

I. General information

NPI: 1205442084
Provider Name (Legal Business Name): ANDREA JEPSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 WESTMINSTER ST
FITCHBURG MA
01420-4766
US

IV. Provider business mailing address

545 WESTMINSTER ST
FITCHBURG MA
01420-4766
US

V. Phone/Fax

Practice location:
  • Phone: 978-345-0685
  • Fax: 978-829-2210
Mailing address:
  • Phone: 978-345-0685
  • Fax: 978-829-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: