=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033584743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J FROST SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2015
-----------------------------------------------------
Last Update Date | 12/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SPRINGFIELD ST ANNEX A, SUITE 6
-----------------------------------------------------
City | CHICOPEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01013-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-594-1122
-----------------------------------------------------
Fax | 413-594-1100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4541
-----------------------------------------------------
City | CHICOPEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-594-1122
-----------------------------------------------------
Fax | 413-594-1100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JOANNA FROST
-----------------------------------------------------
Credential | L.I.C.S.W.
-----------------------------------------------------
Telephone | 413-594-1122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 114330
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------