Provider Demographics
NPI:1760104996
Name:SCHLOSSER, JAIDAN DOSTIE
Entity Type:Individual
Prefix:
First Name:JAIDAN
Middle Name:DOSTIE
Last Name:SCHLOSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1924
Mailing Address - Country:US
Mailing Address - Phone:020-783-7749
Mailing Address - Fax:
Practice Address - Street 1:65 MONROE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1924
Practice Address - Country:US
Practice Address - Phone:020-783-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician