Provider Demographics
NPI:1083944284
Name:TOLLEY, JENNIFER R (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:TOLLEY
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:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-0152
Mailing Address - Country:US
Mailing Address - Phone:508-394-2552
Mailing Address - Fax:
Practice Address - Street 1:206 BREEDS HILL RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1881
Practice Address - Country:US
Practice Address - Phone:508-790-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health