Healthcare Provider Details

I. General information

NPI: 1598477903
Provider Name (Legal Business Name): TAYLOR JEAN AUGUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 WASHINGTON AVE APT 3
WINTHROP MA
02152-1307
US

IV. Provider business mailing address

229 WASHINGTON AVE APT 3
WINTHROP MA
02152-1307
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-0140
  • Fax:
Mailing address:
  • Phone: 978-741-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005315
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: