Provider Demographics
NPI:1841706439
Name:QUELL, JENNIFER COLLEEN (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COLLEEN
Last Name:QUELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NORWEST DR
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1432
Mailing Address - Country:US
Mailing Address - Phone:518-795-8675
Mailing Address - Fax:
Practice Address - Street 1:28 MILL STREET CENTRAL
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3169
Practice Address - Country:US
Practice Address - Phone:508-786-1580
Practice Address - Fax:508-628-6929
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237451423101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1568541670Medicaid