Healthcare Provider Details

I. General information

NPI: 1497397145
Provider Name (Legal Business Name): JAYME DEANN RUSSAW-CLEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E MAIN ST
ORANGE MA
01364-1214
US

IV. Provider business mailing address

102 MAIN ST
GREENFIELD MA
01301-3275
US

V. Phone/Fax

Practice location:
  • Phone: 413-262-4409
  • Fax:
Mailing address:
  • Phone: 413-439-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW230158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: