MEDICARE: MS. JENNIFER LEE LAURENZA LMHC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5446	MA
2	106H00000X	Marriage & Family Therapist	1269	MA

General Provider Information

NPI Number	:	1578682498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LEE LAURENZA LMHC, LMFT

Provider Business Mailing Address
First Line	:	104 CHARLES ELDRIDGE RD
Second Line	:	SUITE 9
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1388
Country	:	US
Telephone Number	:	508-789-9168
Fax Number	:	866-611-0597

Provider Business Practice Location Address
First Line	:	104 CHARLES ELDRIDGE RD
Second Line	:	SUITE 9
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1388
Country	:	US
Telephone Number	:	508-789-9168
Fax Number	:	866-611-0597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	09/30/2011

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