Provider Demographics
NPI:1407807407
Name:TACOVELLI, JERRILYN B (MED, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JERRILYN
Middle Name:B
Last Name:TACOVELLI
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-5238
Mailing Address - Country:US
Mailing Address - Phone:508-675-9975
Mailing Address - Fax:
Practice Address - Street 1:66 TROY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3023
Practice Address - Country:US
Practice Address - Phone:508-676-5708
Practice Address - Fax:508-676-1948
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health