Provider Demographics
NPI:1083416002
Name:WEST, JEAN M (QBA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:WEST
Suffix:
Gender:
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2146
Mailing Address - Country:US
Mailing Address - Phone:508-648-3483
Mailing Address - Fax:
Practice Address - Street 1:44 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2146
Practice Address - Country:US
Practice Address - Phone:508-648-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2600103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst