Provider Demographics
NPI:1447305131
Name:FOLEY, JESSICA F (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:F
Last Name:FOLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7006
Mailing Address - Country:US
Mailing Address - Phone:617-877-0071
Mailing Address - Fax:928-832-0071
Practice Address - Street 1:36 BEAVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7006
Practice Address - Country:US
Practice Address - Phone:617-877-0071
Practice Address - Fax:928-832-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6161OtherLMHC LICENSE NUMBER