Provider Demographics
NPI:1154458404
Name:VALLEAU, JENNIFER (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VALLEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:POTTHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:114950
Mailing Address - Street 1:127 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2619
Mailing Address - Country:US
Mailing Address - Phone:603-661-0309
Mailing Address - Fax:
Practice Address - Street 1:127 ALBION ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2619
Practice Address - Country:US
Practice Address - Phone:603-661-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional