Provider Demographics
NPI:1619019163
Name:THEBERGE IERARDI, JENNIFER ANN (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:THEBERGE IERARDI
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:THEBERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 2025
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351
Mailing Address - Country:US
Mailing Address - Phone:781-871-2051
Mailing Address - Fax:781-871-5558
Practice Address - Street 1:10 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351
Practice Address - Country:US
Practice Address - Phone:781-871-2051
Practice Address - Fax:781-871-5558
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1108191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
46065135OtherPACIFICARE
494156OtherTUFTS
P08717OtherBCBS