Healthcare Provider Details

I. General information

NPI: 1770891954
Provider Name (Legal Business Name): JENNIFER CAROLINA MACGREGOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRINGFIELD ST STE 5D
CHICOPEE MA
01013-2697
US

IV. Provider business mailing address

1 SPRINGFIELD ST STE 5D
CHICOPEE MA
01013-2697
US

V. Phone/Fax

Practice location:
  • Phone: 413-315-7645
  • Fax: 413-241-6093
Mailing address:
  • Phone: 413-315-7645
  • Fax: 413-241-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number10570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: