Provider Demographics
NPI:1508212622
Name:TUFTS, JONNA BLYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:BLYNN
Last Name:TUFTS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DRESSER ST
Mailing Address - Street 2:#2
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3621
Mailing Address - Country:US
Mailing Address - Phone:617-899-0418
Mailing Address - Fax:
Practice Address - Street 1:4 DRESSER ST
Practice Address - Street 2:#2
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3621
Practice Address - Country:US
Practice Address - Phone:617-899-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health