Provider Demographics
NPI:1902457773
Name:ARREDONDO, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HERITAGE DR APT 15
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2034
Mailing Address - Country:US
Mailing Address - Phone:617-955-4734
Mailing Address - Fax:
Practice Address - Street 1:16 HERITAGE DR APT 15
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2034
Practice Address - Country:US
Practice Address - Phone:617-955-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)