Provider Demographics
NPI:1700198215
Name:TENAGLIA, JACQUELYN MARIE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:TENAGLIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARLINGTON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3936
Mailing Address - Country:US
Mailing Address - Phone:516-680-3201
Mailing Address - Fax:
Practice Address - Street 1:75 ARLINGTON ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3986
Practice Address - Country:US
Practice Address - Phone:516-680-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
MA7716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health