Provider Demographics
NPI:1497102727
Name:LIPSCOMB, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1051
Mailing Address - Country:US
Mailing Address - Phone:857-399-1920
Mailing Address - Fax:857-399-1921
Practice Address - Street 1:75 AMORY ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1051
Practice Address - Country:US
Practice Address - Phone:857-399-1920
Practice Address - Fax:857-399-1921
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor