Provider Demographics
NPI:1497983530
Name:THAYER-AWONIYI, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:THAYER-AWONIYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2207 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1155
Mailing Address - Country:US
Mailing Address - Phone:413-599-1201
Mailing Address - Fax:
Practice Address - Street 1:2207 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1155
Practice Address - Country:US
Practice Address - Phone:413-995-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1196571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical