Provider Demographics
NPI:1235388018
Name:BRAZAO, JILL MARIE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:BRAZAO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:HOPKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:33 BONNEY ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2414
Mailing Address - Country:US
Mailing Address - Phone:781-248-3730
Mailing Address - Fax:
Practice Address - Street 1:165 E GROVE ST STE B
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2737
Practice Address - Country:US
Practice Address - Phone:781-248-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000007753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health