Provider Demographics
NPI:1053960385
Name:JACOMINI, CHASE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:JACOMINI
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WORCESTER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5360
Mailing Address - Country:US
Mailing Address - Phone:508-875-1110
Mailing Address - Fax:508-875-1130
Practice Address - Street 1:600 WORCESTER RD STE 201
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5360
Practice Address - Country:US
Practice Address - Phone:508-875-2023
Practice Address - Fax:508-875-1130
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2275663363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health