MEDICARE: JILLIAN MARIANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467187302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN MARIANO

Provider Business Mailing Address
First Line	:	19 BARBARA JEAN ST
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 BARBARA JEAN ST
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1029
Country	:	US
Telephone Number	:	508-596-5441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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Directions to “ JILLIAN MARIANO ” Practice Location

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