Provider Demographics
NPI:1801538103
Name:DANTUONO, JAMIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:DANTUONO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:DIDOMENICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:790 WILLARD ST APT 107
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7479
Mailing Address - Country:US
Mailing Address - Phone:718-887-4910
Mailing Address - Fax:
Practice Address - Street 1:200 CROWN COLONY DR STE 202
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0959
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2249171041C0700X
MA1256831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical