Provider Demographics
NPI:1295357952
Name:JENIKE, ERIC A
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:JENIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-2813
Mailing Address - Country:US
Mailing Address - Phone:617-599-3052
Mailing Address - Fax:
Practice Address - Street 1:75 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-2813
Practice Address - Country:US
Practice Address - Phone:617-599-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor