Provider Demographics
NPI:1710401781
Name:INSTITUTE FOR EMERGING ADULTHOOD INC
Entity Type:Organization
Organization Name:INSTITUTE FOR EMERGING ADULTHOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYCELLE
Authorized Official - Middle Name:MONSANTO
Authorized Official - Last Name:BASFORD-PEQUET
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:510-830-6705
Mailing Address - Street 1:25 MAIN ST STE 219
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3172
Mailing Address - Country:US
Mailing Address - Phone:510-830-6705
Mailing Address - Fax:413-341-3284
Practice Address - Street 1:25 MAIN ST STE 219
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3172
Practice Address - Country:US
Practice Address - Phone:510-830-6705
Practice Address - Fax:413-341-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1190261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty