Provider Demographics
NPI:1508363623
Name:GRAVELLE, JAMIE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GRAVELLE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-3910
Mailing Address - Country:US
Mailing Address - Phone:508-596-4234
Mailing Address - Fax:
Practice Address - Street 1:69 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2787
Practice Address - Country:US
Practice Address - Phone:978-567-6250
Practice Address - Fax:978-567-6285
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical