Doctor Name: | JACKI M BOSWELL |
NPI Number: | 1023340072 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | 5205 |
Business Practice Address: | 165 Quincy St Brockton, MA - 023022988 |
Business Phone Number: | 5088972088 |
Business Fax Number: | 5089872135 |
Mailing Address: | 165 Quincy St, BROCKTON |
State: | MA |
Postal Code: | 023022988 |
Phone Number: | 5088972088 |
Fax Number: | 5089872135 |
NPI Enumeration Date: | 02/02/2010 |
NPI Last Update Date: | 02/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 5205 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |