Healthcare Provider Details

I. General information

NPI: 1356846497
Provider Name (Legal Business Name): MIESHA WILLIAMS-JEANTY M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PLEASANT ST # 782
MALDEN MA
02148-4904
US

IV. Provider business mailing address

51 PLEASANT ST # 782
MALDEN MA
02148-4904
US

V. Phone/Fax

Practice location:
  • Phone: 617-440-4650
  • Fax: 305-402-7906
Mailing address:
  • Phone: 617-440-4650
  • Fax: 305-402-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC12690
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17200
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: