NPIMap

Organization Active NPI

Jeanom LLC

  • Mental Health Counselor
  • Woburn, MA
National Provider Identifier
1053944850
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
JEANOM LLC
Practice address
21 Cummings Park Ste 200
Woburn, MA 01801-2198
Phone
(781) 305-4086
Fax
(781) 305-4087
NPI assigned
Feb 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mona Gebrael El Hachem, LMHCNPI 1750739850
Title
Owner
Phone
(781) 569-5111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

21 Cummings Park Ste 200
Woburn, MA 01801-2198

Mailing address

21 Cummings Park Ste 200
Woburn, MA 01801-2198
Phone (781) 305-4086

Other names 1

  • LIKE A PHOENIX Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220607002097 MA Part B Supplier - Clinic/Group Practice 6507244381 Receives reassigned benefits from 2 practitioners
Practice locations: Woburn, MA

National Provider Directory

National Provider Directory

Locations

21 Cummings Park
Ste 200
Woburn, MA 01801
Phone (781) 305-4086

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1053944850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CUMMINGS PARK STE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018012198",
            "telephone_number": "781-305-4086",
            "fax_number": "603-859-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CUMMINGS PARK STE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018012198",
            "telephone_number": "781-305-4086",
            "fax_number": "781-305-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-20",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "GEBRAEL EL HACHEM",
        "authorized_official_first_name": "MONA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-569-5111",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIKE A PHOENIX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.