Provider Demographics
NPI:1467809053
Name:SHIRLEY, JENNIFER LYNN (LMHC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:LMHC, CRC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, CRC
Mailing Address - Street 1:141 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2533
Mailing Address - Country:US
Mailing Address - Phone:401-903-0324
Mailing Address - Fax:
Practice Address - Street 1:569 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-4356
Practice Address - Country:US
Practice Address - Phone:401-903-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00233417225C00000X
RIMHC01054101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health