Provider Demographics
NPI:1477758464
Name:JENNINGS, DEBORAH LEE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:HILDEBRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:99 SUMMER ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1213
Mailing Address - Country:US
Mailing Address - Phone:617-587-1500
Mailing Address - Fax:617-587-1577
Practice Address - Street 1:231 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4342
Practice Address - Country:US
Practice Address - Phone:508-586-2660
Practice Address - Fax:508-427-1505
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health