Provider Demographics
NPI:1144955386
Name:AVILES, JOSUE M (MA)
Entity type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:M
Last Name:AVILES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 COLLEGE HWY APT G6
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9428
Mailing Address - Country:US
Mailing Address - Phone:207-518-0444
Mailing Address - Fax:
Practice Address - Street 1:125 LIBERTY ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1109
Practice Address - Country:US
Practice Address - Phone:413-301-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health