Individual
CHARLES EDMUND JACQUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 PLEASANT ST, NORTHAMPTON, MA 01060-3909
(413) 584-6855
Mailing address
28 GOULD ST, WARE, MA 01082-1316
(413) 207-1526
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11492
MA
Other
Enumeration date
09/20/2016
Last updated
11/08/2019
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