Provider Demographics
NPI:1962642215
Name:LUCIN-MAIETTA, JENNIFER L (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:LUCIN-MAIETTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1316
Mailing Address - Fax:
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HV0002OtherHPHC
B501027OtherHEALTHSOURCE
SP0334OtherBCBS INDEMNITY
1962642215OtherFCHP
1962642215OtherNHP
6916604OtherAETNA
SP0334OtherBCBS MANAGED CARE
1962642215OtherNPI
B501027OtherCIGNA
908317OtherTUFTS
GROUP #OtherPHCS