Provider Demographics
NPI:1053944850
Name:JEANOM LLC
Entity type:Organization
Organization Name:JEANOM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBRAEL EL HACHEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-569-5111
Mailing Address - Street 1:21 CUMMINGS PARK STE 200
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2198
Mailing Address - Country:US
Mailing Address - Phone:781-305-4086
Mailing Address - Fax:603-859-0156
Practice Address - Street 1:21 CUMMINGS PARK STE 200
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2198
Practice Address - Country:US
Practice Address - Phone:781-305-4086
Practice Address - Fax:781-305-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty