Provider Demographics
NPI:1245798834
Name:YUCATONIS, JESSICA MACKINNON
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MACKINNON
Last Name:YUCATONIS
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 1:9 COMEY AVE
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2902
Mailing Address - Country:US
Mailing Address - Phone:508-816-8118
Mailing Address - Fax:
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2571
Practice Address - Country:US
Practice Address - Phone:508-816-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health