Healthcare Provider Details

I. General information

NPI: 1134023831
Provider Name (Legal Business Name): JAYDEN LOURENCO MACEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ELM ST
WORCESTER MA
01609-2541
US

IV. Provider business mailing address

111 E MAIN ST APT 2
FALL RIVER MA
02724-6347
US

V. Phone/Fax

Practice location:
  • Phone: 774-352-5620
  • Fax:
Mailing address:
  • Phone: 774-488-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: