Provider Demographics
NPI:1942652136
Name:LEIGHTON, JENNIFER MARY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:LEIGHTON
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 1:25 HIGGINS ST
Mailing Address - Street 2:201
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-4007
Mailing Address - Country:US
Mailing Address - Phone:508-410-0440
Mailing Address - Fax:
Practice Address - Street 1:25 HIGGINS ST
Practice Address - Street 2:201
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-4007
Practice Address - Country:US
Practice Address - Phone:508-410-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health