Jakelin Bonilla
Individual provider Active NPI Mental Health Counselor · Randolph, MA
NPI 1225633944 · NPPES record last updated Dec 1, 2020
Key facts
- NPI
- 1225633944
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 41 Pacella Park Dr
Randolph, MA 02368-1755 - Phone
- (781) 437-1381
- NPI assigned
- Dec 1, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MA | Yes |
Addresses
Primary practice location
41 Pacella Park Dr
Randolph, MA 02368-1755
Mailing address
41 Pacella Park Dr
Randolph, MA 02368-1755
Phone (781) 437-1381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110026265E | Medicaid | MA |
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All providers in Randolph, MA · Mental Health Counselor in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.