Healthcare Provider Details

I. General information

NPI: 1447771639
Provider Name (Legal Business Name): JENNIFER BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER BYRD

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 DORCHESTER AVE STE 4
DORCHESTER MA
02122-1386
US

IV. Provider business mailing address

1452 DORCHESTER AVE STE 4
DORCHESTER MA
02122-1386
US

V. Phone/Fax

Practice location:
  • Phone: 857-266-5814
  • Fax:
Mailing address:
  • Phone: 857-266-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: