MEDICARE: JACLYN BOGHOSIAN DEANGELIS LICSW

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
2	1041C0700X	Clinical Social Worker	122793	MA

General Provider Information

NPI Number	:	1538616701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN BOGHOSIAN DEANGELIS LICSW

Provider Business Mailing Address
First Line	:	62 DERBY ST STE 6
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-3718
Country	:	US
Telephone Number	:	781-749-9227
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 DERBY ST STE 6
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-3718
Country	:	US
Telephone Number	:	781-749-9227
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	02/08/2021

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Directions to “ JACLYN BOGHOSIAN DEANGELIS LICSW” Practice Location

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