Provider Demographics
NPI:1356697478
Name:JACKS, TOURINO
Entity type:Individual
Prefix:
First Name:TOURINO
Middle Name:
Last Name:JACKS
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 1:113 MATTAPAN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3145
Mailing Address - Country:US
Mailing Address - Phone:770-940-2322
Mailing Address - Fax:
Practice Address - Street 1:113 MATTAPAN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-3145
Practice Address - Country:US
Practice Address - Phone:770-940-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor