Provider Demographics
NPI:1811775505
Name:OVERTON, JENNIFER A
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:OVERTON
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 1:2487 VT RTE 12 # 16
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05663-6545
Mailing Address - Country:US
Mailing Address - Phone:802-878-8610
Mailing Address - Fax:
Practice Address - Street 1:2487 VT RTE 12 # 16
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05663-6545
Practice Address - Country:US
Practice Address - Phone:802-878-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health