Provider Demographics
NPI:1336283746
Name:MERRICK, JENNIFER (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MERRICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 GRAND VIEW AVE
Mailing Address - Street 2:#3
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3302
Mailing Address - Country:US
Mailing Address - Phone:617-913-2534
Mailing Address - Fax:
Practice Address - Street 1:37 BELMONT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5299
Practice Address - Country:US
Practice Address - Phone:508-580-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker