Basic Information
| Provider Information | |||||||||
| NPI: | 1871545251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELORENZO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DELORENZO | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 225 MAIN ST | ||||||||
| Address2: | STE 14 | ||||||||
| City: | WENHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019841459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003703651 | ||||||||
| FaxNumber: | 8605100020 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 MAIN ST | ||||||||
| Address2: | STE 14 | ||||||||
| City: | WENHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019841459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003703651 | ||||||||
| FaxNumber: | 8605100020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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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 | 1041C0700X | 004505 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.