Provider Demographics
NPI:1619117264
Name:BURTIS, JENNIFER (MSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BURTIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DICKINSON RD # 4
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9065
Mailing Address - Country:US
Mailing Address - Phone:802-579-1522
Mailing Address - Fax:
Practice Address - Street 1:48 SANDERSON ST.
Practice Address - Street 2:SERVICENET
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2715
Practice Address - Country:US
Practice Address - Phone:413-772-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical