Basic Information
| Provider Information | |||||||||
| NPI: | 1790033603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ST. JEAN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 SOUTH ASHBURNHAM RD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786022081 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087914976 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.