Provider Demographics
NPI:1003219148
Name:FREITAS, JENNIFER CAROLYN (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROLYN
Last Name:FREITAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GENDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:172 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3750
Mailing Address - Country:US
Mailing Address - Phone:508-770-0511
Mailing Address - Fax:
Practice Address - Street 1:172 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3750
Practice Address - Country:US
Practice Address - Phone:508-770-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program