Provider Demographics
NPI:1053678383
Name:AULD, JESSICA MARY
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARY
Last Name:AULD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LIVINGSTONE AVE
Mailing Address - Street 2:P. O. BOX 472
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2918
Mailing Address - Country:US
Mailing Address - Phone:781-592-5691
Mailing Address - Fax:781-595-4393
Practice Address - Street 1:112 MARKET ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1125
Practice Address - Country:US
Practice Address - Phone:781-592-5691
Practice Address - Fax:781-595-4393
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS26098983101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor