Provider Demographics
NPI:1932247186
Name:JONES, ABDUL JALIL (MED)
Entity Type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:JALIL
Last Name:JONES
Suffix:
Gender:M
Credentials:MED
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:SHELTON
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1293 COMMONWEALTH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4908
Mailing Address - Country:US
Mailing Address - Phone:617-217-1849
Mailing Address - Fax:617-442-6268
Practice Address - Street 1:55 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1029
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1659101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)