Provider Demographics
NPI:1932746708
Name:BOYLE, JASON (LMHC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BOYLE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52B STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-2001
Mailing Address - Country:US
Mailing Address - Phone:508-667-2696
Mailing Address - Fax:
Practice Address - Street 1:25 UNION ST STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1141
Practice Address - Country:US
Practice Address - Phone:508-317-2323
Practice Address - Fax:508-519-5619
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health