Provider Demographics
NPI:1275181950
Name:JETTE, ALEXIS JETTE (MSW, LCSW, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:JETTE
Last Name:JETTE
Suffix:
Gender:F
Credentials:MSW, LCSW, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BOSTON ST # 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2036
Mailing Address - Country:US
Mailing Address - Phone:845-527-5590
Mailing Address - Fax:
Practice Address - Street 1:625 MOUNT AUBURN ST STE 205A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4530
Practice Address - Country:US
Practice Address - Phone:845-527-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-153818174N00000X
MA2285171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174N00000XOther Service ProvidersLactation Consultant, Non-RN