Provider Demographics
NPI:1902380876
Name:MAYES, JESSIE (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:MAYES
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-2837
Mailing Address - Country:US
Mailing Address - Phone:781-237-6400
Mailing Address - Fax:781-237-1345
Practice Address - Street 1:694 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-2837
Practice Address - Country:US
Practice Address - Phone:781-237-6400
Practice Address - Fax:781-237-1345
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1185691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical