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General NPI Number Information
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NPI Number | 1093374415
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Entity Type | Individual
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Provider Name | JEREMY PAPASODERO LMHC, LPCC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 160 ALEWIFE BROOK PKWY # 1115
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1102
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Country | US
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Telephone | 508-287-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 160 ALEWIFE BROOK PKWY # 1115
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1102
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Country | US
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Telephone | 508-287-2389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12607-MH-CC
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCC18467
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License Number State | CA
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