Provider Demographics
NPI:1407681273
Name:MCCARRISTON, JON MICHAEL
Entity type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
Last Name:MCCARRISTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1152
Mailing Address - Country:US
Mailing Address - Phone:978-821-4992
Mailing Address - Fax:
Practice Address - Street 1:161 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6323
Practice Address - Country:US
Practice Address - Phone:978-373-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health