Provider Demographics
NPI:1336201847
Name:JAROSZ, JUSTINE A (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:A
Last Name:JAROSZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 A FOREST ST
Mailing Address - Street 2:#43
Mailing Address - City:CAMBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:617-876-1651
Mailing Address - Fax:
Practice Address - Street 1:859 WILLIARD STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:617-847-1927
Practice Address - Fax:617-471-9859
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1014151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01370OtherFALON
MAP01370OtherBCBS
MAP01370OtherFALON