Provider Demographics
NPI:1932684537
Name:HOUGHTON, JENNIFER M (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HOUGHTON
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 1:86 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2831
Mailing Address - Country:US
Mailing Address - Phone:617-538-8544
Mailing Address - Fax:
Practice Address - Street 1:166 MOUNT PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1352
Practice Address - Country:US
Practice Address - Phone:508-279-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical