Provider Demographics
NPI:1487222360
Name:JENNY WHITE KULIESIS LICSW, LLC
Entity Type:Organization
Organization Name:JENNY WHITE KULIESIS LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:KULIESIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-272-7723
Mailing Address - Street 1:661 MASSACHUSETTS AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5001
Mailing Address - Country:US
Mailing Address - Phone:617-272-7723
Mailing Address - Fax:617-485-1698
Practice Address - Street 1:661 MASSACHUSETTS AVE STE 21
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5001
Practice Address - Country:US
Practice Address - Phone:617-272-7723
Practice Address - Fax:617-485-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty