Healthcare Provider Details

I. General information

NPI: 1417501404
Provider Name (Legal Business Name): JENNIFER NEWCOMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S MAIN ST STE 210
FALL RIVER MA
02721-5355
US

IV. Provider business mailing address

99 S MAIN ST STE 210
FALL RIVER MA
02721-5355
US

V. Phone/Fax

Practice location:
  • Phone: 781-440-0400
  • Fax:
Mailing address:
  • Phone: 781-440-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110026265E
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: