Provider Demographics
NPI:1780956847
Name:MOSCATO, JASON (LMHC, RN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MOSCATO
Suffix:
Gender:M
Credentials:LMHC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 MAIN ST
Mailing Address - Street 2:STE 301
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5042
Mailing Address - Country:US
Mailing Address - Phone:781-246-2010
Mailing Address - Fax:781-246-1448
Practice Address - Street 1:338 MAIN ST
Practice Address - Street 2:STE 301
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5042
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:781-246-1448
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health