Provider Demographics
NPI:1902896491
Name:TIMBERLAKE, JASSY (MED, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JASSY
Middle Name:
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN ST
Mailing Address - Street 2:SUIE 103
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1492
Mailing Address - Country:US
Mailing Address - Phone:413-587-0095
Mailing Address - Fax:413-587-0096
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1492
Practice Address - Country:US
Practice Address - Phone:413-587-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist