Provider Demographics
NPI:1386895928
Name:JAKUBIAK, CAROLYN (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:JAKUBIAK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583
Mailing Address - Country:US
Mailing Address - Phone:508-320-1583
Mailing Address - Fax:508-825-4419
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1464
Practice Address - Country:US
Practice Address - Phone:508-366-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health