Provider Demographics
NPI:1548557663
Name:STEPHENS, JENNIFER MARIE (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PLEASANT ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2570
Mailing Address - Country:US
Mailing Address - Phone:203-788-0079
Mailing Address - Fax:
Practice Address - Street 1:607 PLEASANT ST
Practice Address - Street 2:SUITE 115
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2570
Practice Address - Country:US
Practice Address - Phone:203-788-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health