Healthcare Provider Details

I. General information

NPI: 1700711561
Provider Name (Legal Business Name): JALEN ECHEVARRIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 BLOSSOM ST
LYNN MA
01902-4508
US

IV. Provider business mailing address

17 1/2 PALEOLOGOS ST APT 2
PEABODY MA
01960-4452
US

V. Phone/Fax

Practice location:
  • Phone: 339-883-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS94089706
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: