Provider Demographics
NPI:1225298755
Name:TROTT, JENNIFER (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:TROTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3964
Mailing Address - Country:US
Mailing Address - Phone:508-830-1234
Mailing Address - Fax:508-830-1191
Practice Address - Street 1:2 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3964
Practice Address - Country:US
Practice Address - Phone:508-830-1234
Practice Address - Fax:508-830-1191
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1165401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002408701Medicare Oscar/Certification