Provider Demographics
NPI:1346404738
Name:HEALY, JASON (LICSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HEALY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4297
Mailing Address - Country:US
Mailing Address - Phone:413-977-2402
Mailing Address - Fax:617-863-5422
Practice Address - Street 1:16 GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2573
Practice Address - Country:US
Practice Address - Phone:413-977-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1172091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA117209OtherCOMMONWEALTH OF MASSACHUSETTS