Provider Demographics
NPI:1497003792
Name:JG THERAPY LLC
Entity Type:Organization
Organization Name:JG THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-862-9482
Mailing Address - Street 1:79 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1811
Mailing Address - Country:US
Mailing Address - Phone:781-862-9482
Mailing Address - Fax:
Practice Address - Street 1:79 NORTH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1811
Practice Address - Country:US
Practice Address - Phone:781-862-9482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1013971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1629117056OtherBLUE CROSS BLUE SHIELD INDIVIDUAL NPI GIVEN TO SOLE PROVIDER IN JG THERAPY LLC
MAP01571OtherLEGACY # FOR INDIVIDUAL PROVIDER IN JG THERAPY LLC