Provider Demographics
NPI:1952620015
Name:WARKENTIN, JENNIFER BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BETH
Last Name:WARKENTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BROAD ST STE B206
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2565
Mailing Address - Country:US
Mailing Address - Phone:781-693-3200
Mailing Address - Fax:844-439-7801
Practice Address - Street 1:43 BROAD ST STE B206
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2565
Practice Address - Country:US
Practice Address - Phone:781-593-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9122103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12190619OtherCAQH