Provider Demographics
NPI:1780919001
Name:REGO, JENNIFER H (LICSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:REGO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:H
Other - Last Name:AUERBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 CONCORD STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2717
Mailing Address - Country:US
Mailing Address - Phone:617-894-6974
Mailing Address - Fax:
Practice Address - Street 1:965 CONCORD STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:781-647-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1188241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical