Healthcare Provider Details

I. General information

NPI: 1720907470
Provider Name (Legal Business Name): JILLIAN BAYROUTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 NORTON ST
WORCESTER MA
01605-3311
US

IV. Provider business mailing address

380 COBURN AVE APT 2
WORCESTER MA
01604-1205
US

V. Phone/Fax

Practice location:
  • Phone: 508-948-8684
  • Fax: 508-852-5838
Mailing address:
  • Phone: 508-948-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: