Provider Demographics
NPI:1235736489
Name:BOYLE, JILLIAN M (LMHC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:M
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAIN ST APT 5
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3828
Mailing Address - Country:US
Mailing Address - Phone:781-572-5890
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN ST APT 5
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3828
Practice Address - Country:US
Practice Address - Phone:781-572-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11866-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health