Provider Demographics
NPI:1417358326
Name:SHENG, JENNIFER LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:SHENG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2627
Mailing Address - Country:US
Mailing Address - Phone:570-417-8934
Mailing Address - Fax:
Practice Address - Street 1:24 KNOX ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2627
Practice Address - Country:US
Practice Address - Phone:781-208-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1229201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000023532OtherBMC
MA042611055OtherTAX ID
MA1303287OtherMBHP
MAM18633OtherBCBS
MA99618201OtherNETWORK HEALTH
MA1303287Medicaid
MA1004745OtherNHP