Provider Demographics
NPI:1629760574
Name:ZAMUDIO PARDO, JENNY ADRIANA
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ADRIANA
Last Name:ZAMUDIO PARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850714
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02185-0714
Mailing Address - Country:US
Mailing Address - Phone:404-468-2931
Mailing Address - Fax:
Practice Address - Street 1:550 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7373
Practice Address - Country:US
Practice Address - Phone:404-468-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty