Healthcare Provider Details

I. General information

NPI: 1447578638
Provider Name (Legal Business Name): JONATHAN C SCHULMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 HOLBROOK RD
QUINCY MA
02171-2741
US

IV. Provider business mailing address

460 QUINCY AVE
QUINCY MA
02169-8130
US

V. Phone/Fax

Practice location:
  • Phone: 857-293-9296
  • Fax:
Mailing address:
  • Phone: 617-847-1950
  • Fax: 617-774-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: