Provider Demographics
NPI:1992686745
Name:MOTA, JASON E
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:MOTA
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 1:591 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3326
Mailing Address - Country:US
Mailing Address - Phone:774-315-4929
Mailing Address - Fax:774-315-4929
Practice Address - Street 1:591 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3326
Practice Address - Country:US
Practice Address - Phone:774-315-4929
Practice Address - Fax:774-315-4929
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician