Provider Demographics
NPI:1255217592
Name:TAVARES-REID, JAEDA
Entity type:Individual
Prefix:
First Name:JAEDA
Middle Name:
Last Name:TAVARES-REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-2139
Mailing Address - Country:US
Mailing Address - Phone:617-953-2527
Mailing Address - Fax:
Practice Address - Street 1:108 GROVE ST STE LL11
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2677
Practice Address - Country:US
Practice Address - Phone:508-304-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical