Provider Demographics
NPI:1598262321
Name:AL-JUBORY, ESRAA M
Entity Type:Individual
Prefix:
First Name:ESRAA
Middle Name:M
Last Name:AL-JUBORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 TIRRELL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1661
Mailing Address - Country:US
Mailing Address - Phone:857-399-6469
Mailing Address - Fax:
Practice Address - Street 1:66 TIRRELL ST APT 1
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1661
Practice Address - Country:US
Practice Address - Phone:857-399-6469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst