Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 530188 | MA |
Y | 1041C0700X | Clinical Social Worker | 226980 | MA |
NPI | 1073271854 |
---|---|
Provider Name | Jillian Gaudet |
First Address | Peabody, MA 01960-1008 |
Second Address | Waltham, MA 02453-2741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |