Basic Information
| Provider Information | |||||||||
| NPI: | 1447912407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES REEVES | ||||||||
| FirstName: | AMARA | ||||||||
| MiddleName: | KNAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 DUDLEY ST | ||||||||
| Address2: | |||||||||
| City: | ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192732 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 504 DUDLEY ST | ||||||||
| Address2: | |||||||||
| City: | ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174456655 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2021 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.