| NPI | 1760965479 |
|---|---|
| Former Name | JACQUELYN MARY MAYO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000224046) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 2935) |
| Enumeration Date | 2018-09-09 |
| Last Update Date | 2023-07-14 |