Basic Information
| Provider Information | |||||||||
| NPI: | 1053960385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOMINI | ||||||||
| FirstName: | CHASE | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 CHESTNUT ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024457580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605432842 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 WORCESTER RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017025360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088752023 | ||||||||
| FaxNumber: | 5088751130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2019 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | RN2275663 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.