Basic Information
| Provider Information | |||||||||
| NPI: | 1861740623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 LAKEVIEW AVE | ||||||||
| Address2: | APARTMENT #1 | ||||||||
| City: | DRACUT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018263421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082462781 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 UNION ST | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018401866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786884830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.