Provider Demographics
NPI:1801229679
Name:WON, JEANETTE MICHELLE (LMHC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MICHELLE
Last Name:WON
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 1:677 PARKER ST
Mailing Address - Street 2:APT. B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3017
Mailing Address - Country:US
Mailing Address - Phone:617-378-1477
Mailing Address - Fax:
Practice Address - Street 1:859 WILLARD ST STE 430
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7490
Practice Address - Country:US
Practice Address - Phone:617-745-2737
Practice Address - Fax:617-471-9859
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health