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Individual

JALEESA LARA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
110 BOSTON ST, SALEM, MA 01970-1402
(978) 744-7905
Mailing address
33 POND ST, BEVERLY, MA 01915-4324

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
S09873554
MA
101YM0800X
Mental Health Counselor
S09873554
MA
103T00000X
Psychologist
S09873554
MA
104100000X
Social Worker
S09873554
MA

Other

Enumeration date
09/30/2013
Last updated
09/30/2013
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