Healthcare Provider Details

I. General information

NPI: 1538088232
Provider Name (Legal Business Name): JACKIE SURDAN, LMHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MAIN ST STE 14
WINCHESTER MA
01890-2940
US

IV. Provider business mailing address

540 MAIN ST STE 14
WINCHESTER MA
01890-2940
US

V. Phone/Fax

Practice location:
  • Phone: 617-312-8621
  • Fax:
Mailing address:
  • Phone: 617-312-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE CLAIRE SURDAN
Title or Position: OWNER
Credential: LMHC
Phone: 617-312-8621