Provider Demographics
NPI:1336684810
Name:INSTITUTE FOR EMERGING ADULTHOOD
Entity Type:Organization
Organization Name:INSTITUTE FOR EMERGING ADULTHOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYCELLE
Authorized Official - Middle Name:MONSANTO
Authorized Official - Last Name:PEQUET
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-279-4984
Mailing Address - Street 1:25 MAIN ST STE 218
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3130
Mailing Address - Country:US
Mailing Address - Phone:413-279-4984
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST STE 218
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3130
Practice Address - Country:US
Practice Address - Phone:413-279-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health