Provider Demographics
NPI:1487008173
Name:LAVIOLETTE, JESSICA MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:LAVIOLETTE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:62 WARE ST
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-3136
Mailing Address - Country:US
Mailing Address - Phone:508-867-4451
Mailing Address - Fax:508-867-3555
Practice Address - Street 1:62 WARE ST
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585-3136
Practice Address - Country:US
Practice Address - Phone:508-867-4451
Practice Address - Fax:508-867-3555
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11009OtherLICENSE OF MENTAL HEALTH COUNSELING (LMHC)