Healthcare Provider Details

I. General information

NPI: 1992587943
Provider Name (Legal Business Name): JASON MISHOE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 CENTRE ST STE 220
NEWTON MA
02459-1553
US

IV. Provider business mailing address

1280 CENTRE ST STE 220
NEWTON MA
02459-1553
US

V. Phone/Fax

Practice location:
  • Phone: 352-256-9347
  • Fax: 617-344-3782
Mailing address:
  • Phone:
  • Fax: 617-344-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JASON MISHOE
Title or Position: PROVIDER
Credential: NP
Phone: 352-256-9347