Provider Demographics
NPI:1326039694
Name:DUMOND, JAN MARIE
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:MARIE
Last Name:DUMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:MARIE
Other - Last Name:DUMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:329 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2049
Mailing Address - Country:US
Mailing Address - Phone:413-665-1568
Mailing Address - Fax:413-665-3477
Practice Address - Street 1:256 N PLEASANT ST
Practice Address - Street 2:STE 3
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1729
Practice Address - Country:US
Practice Address - Phone:413-575-3103
Practice Address - Fax:413-665-3477
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA105581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA#DU P21913Medicare ID - Type UnspecifiedMEDICARE