Provider Demographics
NPI:1053400895
Name:JAY, PAUL BRADFORD (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRADFORD
Last Name:JAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LINDENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-438-7279
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:NORTH SHORE MEDICAL CENTER
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-354-4550
Practice Address - Fax:978-745-9021
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2053611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical