Provider Demographics
NPI:1366050965
Name:PARISELLA, JORDAN JP (BT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JP
Last Name:PARISELLA
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SIMON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3184
Mailing Address - Country:US
Mailing Address - Phone:978-624-6149
Mailing Address - Fax:
Practice Address - Street 1:15 SIMON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3184
Practice Address - Country:US
Practice Address - Phone:978-624-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician