Provider Demographics
NPI:1649702143
Name:AYLSWORTH, JASON
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:AYLSWORTH
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 1:11 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1221
Mailing Address - Country:US
Mailing Address - Phone:339-224-0391
Mailing Address - Fax:
Practice Address - Street 1:58 CONCORD ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2602
Practice Address - Country:US
Practice Address - Phone:339-224-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health