Provider Demographics
NPI:1164062485
Name:BORA, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 GREY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-1354
Mailing Address - Country:US
Mailing Address - Phone:802-863-6744
Mailing Address - Fax:
Practice Address - Street 1:462 HEGEMAN AVE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3187
Practice Address - Country:US
Practice Address - Phone:877-448-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician