Provider Demographics
NPI:1619027091
Name:ADAMS, JEANNINE BRETON
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:BRETON
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:
Other - Last Name:BRETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:77 RUMFORD AVE
Mailing Address - Street 2:CHILDREN'S CHARTER DIV. OF KEY PROGRAM, INC.
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3872
Mailing Address - Country:US
Mailing Address - Phone:781-894-4307
Mailing Address - Fax:781-894-1195
Practice Address - Street 1:77 RUMFORD AVE
Practice Address - Street 2:CHILDREN'S CHARTER DIV. OF KEY PROGRAM, INC.
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3872
Practice Address - Country:US
Practice Address - Phone:781-894-4307
Practice Address - Fax:781-894-1195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10170261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical