Jacquelyn Mary Mayo, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12336 Issued in MA

Practice address

173 South River Road
Unit 3
Bedford, NH 03110

Phone

(603) 472-5279

Fax

(603) 488-1682

NPI assigned

Sep 9, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Jacquelyn Mayo Georgallas Former name

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SB Transitional Sub, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brockton, MA
  • NPI 1962091173
  Medicare reassignment NPD
• Counseling Associates of Ma & NH, LLC

  • Clinical Social Worker
  • Methuen, MA
  • NPI 1891710042
  NPD
• Habit Opco, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fitchburg, MA
  • NPI 1255034880
  NPD (past)

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

{
    "created_epoch": "1536451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1760965479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 SOUTH RIVER ROAD",
            "address_2": "UNIT 3",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "03110",
            "telephone_number": "603-472-5279",
            "fax_number": "603-488-1682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 SOUTH RIVER ROAD",
            "address_2": "UNIT 3",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "03110",
            "telephone_number": "603-472-5279",
            "fax_number": "603-488-1682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 Old Canal Dr",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "MA",
            "postal_code": "018512730",
            "country_code": "US",
            "telephone_number": "978-453-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYO",
        "first_name": "JACQUELYN",
        "middle_name": "MARY",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-09",
        "last_updated": "2025-05-28",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "2935",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "000224046",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "12336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "GEORGALLAS",
            "middle_name": "MAYO",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Courtney Ann Matuozzi, OTR/L
• Maxi Drug North Inc
• Maxim Healthcare Services, Inc.
• Elizabeth Pylant Bransford Maxwell, MD
• Eric May
• Lisa M Mazzini, PT
• Keith James McAvoy, M.D.
• Ann Marie McCarthy, CLC
• Emily McCarthy
• Judith M. McCole, DO

• Clinical Social Worker in Bedford, NH
• Providers in Bedford, NH by specialty
• Clinical Social Worker in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.