Provider Demographics
NPI:1952746380
Name:FOWLER, JENNIFER ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:CROCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:3 COURTHOUSE LN
Mailing Address - Street 2:BUILDING B, SUITE #8
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1722
Mailing Address - Country:US
Mailing Address - Phone:978-710-7569
Mailing Address - Fax:978-710-7757
Practice Address - Street 1:3 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1722
Practice Address - Country:US
Practice Address - Phone:978-710-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4967101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0030445OtherMEDICARE PART B PTAN