Healthcare Provider Details

I. General information

NPI: 1790616480
Provider Name (Legal Business Name): MARIA CAMILA JARAMILLO LSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CIRCLE AVE
LYNN MA
01905-3050
US

IV. Provider business mailing address

706 BROUGHTON DR
BEVERLY MA
01915-1834
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-2493
  • Fax:
Mailing address:
  • Phone: 781-595-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLSWA4060567
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: