Healthcare Provider Details

I. General information

NPI: 1932999703
Provider Name (Legal Business Name): MAYA JONES BERASALUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 WORCESTER ST
WEST BOYLSTON MA
01583-1751
US

IV. Provider business mailing address

340 MAPLE ST STE 400
MARLBOROUGH MA
01752-3200
US

V. Phone/Fax

Practice location:
  • Phone: 508-835-1735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: