Provider Demographics
NPI: | 1699037374 |
---|---|
Name: | JMA COUNSELING |
Entity type: | Organization |
Organization Name: | JMA COUNSELING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER; CLINICAL SOCIAL WORKER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JORDANA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | AMATO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LICSW |
Authorized Official - Phone: | 413-687-4885 |
Mailing Address - Street 1: | PO BOX 60263 |
Mailing Address - Street 2: | |
Mailing Address - City: | FLORENCE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01062-0263 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 413-687-4885 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7 HADLEY ST |
Practice Address - Street 2: | SUITE 2L |
Practice Address - City: | SOUTH HADLEY |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01075-1147 |
Practice Address - Country: | US |
Practice Address - Phone: | 413-687-4885 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-08 |
Last Update Date: | 2012-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 115554 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |