Provider Demographics
NPI:1871651000
Name:SOLDANO, JENNIFER JANE (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:SOLDANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GREELEY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1029
Mailing Address - Country:US
Mailing Address - Phone:978-368-0181
Mailing Address - Fax:978-612-0039
Practice Address - Street 1:221 GREELEY ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1029
Practice Address - Country:US
Practice Address - Phone:978-368-0181
Practice Address - Fax:978-612-0039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health