Provider Demographics
NPI:1477312064
Name:NOLIN, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:NOLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 OSGOOD ST APT T704
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3018
Mailing Address - Country:US
Mailing Address - Phone:351-667-5428
Mailing Address - Fax:
Practice Address - Street 1:51 OSGOOD ST APT T704
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3018
Practice Address - Country:US
Practice Address - Phone:351-667-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS60659723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty