Healthcare Provider Details

I. General information

NPI: 1497983530
Provider Name (Legal Business Name): JAIME THAYER-AWONIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAIME THAYER

II. Dates (important events)

Enumeration Date: 06/28/2009
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 BOSTON RD
WILBRAHAM MA
01095-1155
US

IV. Provider business mailing address

2207 BOSTON RD
WILBRAHAM MA
01095-1155
US

V. Phone/Fax

Practice location:
  • Phone: 413-995-1201
  • Fax:
Mailing address:
  • Phone: 413-599-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119657
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: