Healthcare Provider Details

I. General information

NPI: 1275205510
Provider Name (Legal Business Name): SURABHI JAIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MAIN ST STE 2
HOPKINTON MA
01748-1193
US

IV. Provider business mailing address

77 MAIN ST STE 2
HOPKINTON MA
01748-1193
US

V. Phone/Fax

Practice location:
  • Phone: 508-589-5333
  • Fax: 774-250-2693
Mailing address:
  • Phone: 508-589-5333
  • Fax: 774-250-2693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: