Provider Demographics
NPI:1831525401
Name:BRUMFIELD, JENNIFER R (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:BRUMFIELD
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:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44258
Mailing Address - Country:US
Mailing Address - Phone:330-410-8444
Mailing Address - Fax:330-721-8400
Practice Address - Street 1:221 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2217
Practice Address - Country:US
Practice Address - Phone:330-410-8444
Practice Address - Fax:330-721-8400
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X
OHE1200623101YP2500X
OHC1200623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional