Provider Demographics
NPI:1669620399
Name:HANNA, JENNIFER TRACY (LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:TRACY
Last Name:HANNA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 COURT RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2830
Mailing Address - Country:US
Mailing Address - Phone:617-839-6767
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2349
Practice Address - Country:US
Practice Address - Phone:617-839-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000006686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health