Provider Demographics
NPI:1831419415
Name:LAVIOLETTE, JASON CHARLES
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHARLES
Last Name:LAVIOLETTE
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 1:40C CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1819
Mailing Address - Country:US
Mailing Address - Phone:508-264-1630
Mailing Address - Fax:
Practice Address - Street 1:3086 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4801
Practice Address - Country:US
Practice Address - Phone:508-295-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)