Jacobo, Michelle Carley

Jacobo, Michelle Carley is an individual health care provider with primary practice located at 55 Fruit St Warren 1220, Boston MA 02114-2621. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Jacobo, Michelle Carley can be contacted via phone (617) 724-9119.

Contact Information

Primary practice address
55 Fruit St Warren 1220 Boston MA 02114-2621
Phone: (617) 724-9119
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 7365 Massachusetts

Profile Details

NPI number 1194798769
LBN Legal business name Jacobo, Michelle Carley
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Jun 26th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194798769 NPPES
Massachusetts MEDICAID 0500259
Massachusetts Other 723413
Massachusetts Other W06093

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