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General NPI Number Information
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NPI Number | 1760965479
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Entity Type | Individual
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Provider Name | JACQUELYN MARY MAYO LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 173 SOUTH RIVER ROAD UNIT 3
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City | BEDFORD
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State | NH
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Zip | 03110
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Country | US
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Telephone | 603-472-5279
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Fax | 603-488-1682
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Provider Business Mailing Address
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Address Line | 173 SOUTH RIVER ROAD UNIT 3
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City | BEDFORD
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State | NH
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Zip | 03110
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Country | US
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Telephone | 603-472-5279
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Fax | 603-488-1682
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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 | 2935
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000224046
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12336
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License Number State | MA
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