Provider Demographics
NPI:1215205877
Name:LEFORT, JENNIFER MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:LEFORT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 THATCHER RD
Mailing Address - Street 2:127 HILLS NORTH
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9362
Mailing Address - Country:US
Mailing Address - Phone:413-545-2337
Mailing Address - Fax:413-545-9602
Practice Address - Street 1:111 THATCHER RD
Practice Address - Street 2:127 HILLS NORTH
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9362
Practice Address - Country:US
Practice Address - Phone:413-545-2337
Practice Address - Fax:413-545-9602
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9451103TC0700X
CT2887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical