Provider Demographics
NPI:1134949845
Name:APOLLON, JAYDEN
Entity type:Individual
Prefix:
First Name:JAYDEN
Middle Name:
Last Name:APOLLON
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 1:33 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005
Mailing Address - Country:US
Mailing Address - Phone:774-303-7819
Mailing Address - Fax:
Practice Address - Street 1:9 VILLAGE INN RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1643
Practice Address - Country:US
Practice Address - Phone:978-571-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASA5290238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)