Provider Demographics
NPI:1134676943
Name:SZULAK, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SZULAK
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 1:185 LINCOLN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1743
Mailing Address - Country:US
Mailing Address - Phone:617-468-4160
Mailing Address - Fax:
Practice Address - Street 1:185 LINCOLN ST STE 210
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1743
Practice Address - Country:US
Practice Address - Phone:617-468-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1232911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical