Provider Demographics
NPI:1245943943
Name:JAYME SHORIN LICSW
Entity type:Organization
Organization Name:JAYME SHORIN LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHORIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-354-0807
Mailing Address - Street 1:930 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3234
Mailing Address - Country:US
Mailing Address - Phone:617-354-0807
Mailing Address - Fax:
Practice Address - Street 1:930 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3234
Practice Address - Country:US
Practice Address - Phone:617-354-0807
Practice Address - Fax:617-844-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty