Healthcare Provider Details

I. General information

NPI: 1104863497
Provider Name (Legal Business Name): JENNIFER FINE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST BUILDING 5 ROOM C-117
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

1049 BAY RD
SHARON MA
02067-2402
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-1488
  • Fax: 774-826-2571
Mailing address:
  • Phone: 774-826-1488
  • Fax: 774-826-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1022082
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: