1477758464 NPI number — MS. DEBORAH LEE JENNINGS L.M.H.C.

Table of content: MS. DEBORAH LEE JENNINGS L.M.H.C. (NPI 1477758464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477758464 NPI number — MS. DEBORAH LEE JENNINGS L.M.H.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
DEBORAH
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.H.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILDEBRANT
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.H.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477758464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 SUMMER ST
Provider Second Line Business Mailing Address:
6TH FLOOR
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02110-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-587-1500
Provider Business Mailing Address Fax Number:
617-587-1577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-586-2660
Provider Business Practice Location Address Fax Number:
508-427-1505
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4610 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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