Provider Demographics
NPI:1164507539
Name:HANOWELL, JENNIFER CARISSA (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CARISSA
Last Name:HANOWELL
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1 ESSEX CENTER DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-538-3600
Mailing Address - Fax:978-538-3610
Practice Address - Street 1:1 ESSEX CENTER DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-3600
Practice Address - Fax:978-538-3610
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-12-12
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Provider Licenses
StateLicense IDTaxonomies
NE8292084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100179AMedicaid