Provider Demographics
NPI:1043694060
Name:PRICE, JENNIFER (MA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 ROCKLAND ST
Mailing Address - Street 2:APT. 3F
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1966
Mailing Address - Country:US
Mailing Address - Phone:508-314-4380
Mailing Address - Fax:
Practice Address - Street 1:82 ROCKLAND ST
Practice Address - Street 2:APT. 3F
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1966
Practice Address - Country:US
Practice Address - Phone:508-314-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health