Provider Demographics
NPI:1235851312
Name:JELSMA, CARLINE M (BA, MSW PENDING)
Entity Type:Individual
Prefix:
First Name:CARLINE
Middle Name:M
Last Name:JELSMA
Suffix:
Gender:F
Credentials:BA, MSW PENDING
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:JELSMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1402
Mailing Address - Country:US
Mailing Address - Phone:978-998-9699
Mailing Address - Fax:
Practice Address - Street 1:110 BOSTON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1402
Practice Address - Country:US
Practice Address - Phone:978-998-9699
Practice Address - Fax:978-740-9145
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty