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General NPI Number Information
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NPI Number | 1215474788
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Entity Type | Individual
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Provider Name | KATHERINE JELLISON LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 184 PLEASANT VALLEY ST STE 1-206
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City | METHUEN
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State | MA
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Zip | 01844-5855
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Country | US
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Telephone | 978-683-0133
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Fax | 978-683-9818
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Provider Business Mailing Address
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Address Line | 1715 BROADWAY
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City | SAUGUS
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State | MA
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Zip | 01906-4703
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Country | US
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Telephone | 781-676-4223
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Fax | 857-444-9503
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW122137
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License Number State | MA
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