Provider Demographics
NPI:1710295993
Name:DELLASANTA, JENNIFER REID (ICADC, LADC, MCAP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REID
Last Name:DELLASANTA
Suffix:
Gender:F
Credentials:ICADC, LADC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2142
Mailing Address - Country:US
Mailing Address - Phone:774-253-2575
Mailing Address - Fax:
Practice Address - Street 1:29 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5546
Practice Address - Country:US
Practice Address - Phone:978-786-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1423AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)