Healthcare Provider Details

I. General information

NPI: 1356258149
Provider Name (Legal Business Name): JENNIFER LAUREN WHYTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORBES RD # 250E
BRAINTREE MA
02184-2605
US

IV. Provider business mailing address

5 LOEW CIR
MILTON MA
02186-1043
US

V. Phone/Fax

Practice location:
  • Phone: 781-630-4663
  • Fax:
Mailing address:
  • Phone: 650-380-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10001623
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: