=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700707890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY JEANTY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 MAIN ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02301-4342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-480-2190
-----------------------------------------------------
Fax | 508-427-1505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 ALGONQUIN ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02302-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-381-2636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------