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General NPI Number Information
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NPI Number | 1790359446
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Entity Type | Individual
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Provider Name | SARA ELISABETH JEZOWSKI
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Gender | Female
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 3 BLACKBURN CTR
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City | GLOUCESTER
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State | MA
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Zip | 01930-2268
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Country | US
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Telephone | 978-559-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 4 THOMAS RD
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City | DANVERS
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State | MA
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Zip | 01923-1633
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Country | US
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Telephone |
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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 |
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License Number State |
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