Provider Demographics
NPI:1255754222
Name:RIEKE, JENNY (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:RIEKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ANTRIM ST # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1132
Mailing Address - Country:US
Mailing Address - Phone:857-919-4150
Mailing Address - Fax:
Practice Address - Street 1:100 ANTRIM ST # 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1132
Practice Address - Country:US
Practice Address - Phone:857-919-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health