Provider Demographics
NPI:1275205510
Name:JAIN, SURABHI
Entity Type:Individual
Prefix:
First Name:SURABHI
Middle Name:
Last Name:JAIN
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 1:73 NEWBURY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3053
Mailing Address - Country:US
Mailing Address - Phone:617-223-7549
Mailing Address - Fax:815-377-2574
Practice Address - Street 1:73 NEWBURY ST STE 400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3053
Practice Address - Country:US
Practice Address - Phone:617-223-7549
Practice Address - Fax:815-377-2574
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician