Provider Demographics
NPI:1407247836
Name:WEAVER-BREITENBECHER, JENNIFER L (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WEAVER-BREITENBECHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113987
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-0187
Mailing Address - Country:US
Mailing Address - Phone:401-349-4269
Mailing Address - Fax:
Practice Address - Street 1:1635 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4025
Practice Address - Country:US
Practice Address - Phone:401-349-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health