Healthcare Provider Details

I. General information

NPI: 1275379166
Provider Name (Legal Business Name): JILL FURUMOTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CLARKE ST
LEXINGTON MA
02421-4988
US

IV. Provider business mailing address

10 LARSON CIR
BURLINGTON MA
01803-5121
US

V. Phone/Fax

Practice location:
  • Phone: 617-388-5566
  • Fax:
Mailing address:
  • Phone: 617-388-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JILL FURUMOTO
Title or Position: EXECUTIVE OFFICER
Credential: LMHC
Phone: 617-388-5566