Healthcare Provider Details

I. General information

NPI: 1184951915
Provider Name (Legal Business Name): LAURA P. JACINTO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 SOUTH ST
WARE MA
01082-1616
US

IV. Provider business mailing address

96 SOUTH ST
WARE MA
01082-1616
US

V. Phone/Fax

Practice location:
  • Phone: 413-967-6241
  • Fax: 413-967-9807
Mailing address:
  • Phone: 413-967-6241
  • Fax: 413-967-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: