Provider Demographics
NPI:1871290973
Name:MA JEAN-CHARLES PSYCHOTHERAPY AND CONSULTING LLC
Entity type:Organization
Organization Name:MA JEAN-CHARLES PSYCHOTHERAPY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEAN-CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-929-1332
Mailing Address - Street 1:11 CEDARCREST AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4341
Mailing Address - Country:US
Mailing Address - Phone:781-929-1332
Mailing Address - Fax:
Practice Address - Street 1:1 ARNOLD CIR STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2250
Practice Address - Country:US
Practice Address - Phone:617-680-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty