Provider Demographics
NPI:1568578128
Name:JELINEK, MARYLOU (LMHC)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:JELINEK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HAZEN AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6419
Mailing Address - Country:US
Mailing Address - Phone:617-271-4700
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3723
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:978-475-7620
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health