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General NPI Number Information
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NPI Number | 1538088232
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Entity Type | Organization
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Legal Business Name | JACKIE SURDAN, LMHC, LLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 540 MAIN ST STE 14
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City | WINCHESTER
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State | MA
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Zip | 01890-2940
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Country | US
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Telephone | 617-312-8621
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Fax |
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Provider Business Mailing Address
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Address Line | 540 MAIN ST STE 14
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City | WINCHESTER
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State | MA
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Zip | 01890-2940
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Country | US
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Telephone | 617-312-8621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE CLAIRE SURDAN
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Credential | LMHC
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Telephone | 617-312-8621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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