Healthcare Provider Details

I. General information

NPI: 1841154333
Provider Name (Legal Business Name): JEFFREY GIAMMALVO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 ASHLEY BLVD
NEW BEDFORD MA
02745-5404
US

IV. Provider business mailing address

114 ROTCH ST
NEW BEDFORD MA
02740-2453
US

V. Phone/Fax

Practice location:
  • Phone: 774-992-7273
  • Fax:
Mailing address:
  • Phone: 508-965-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: