Healthcare Provider Details

I. General information

NPI: 1366183378
Provider Name (Legal Business Name): ALEXIS MARIE JELM LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12836
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12836
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: