Healthcare Provider Details

I. General information

NPI: 1912664087
Provider Name (Legal Business Name): JENNIFER JO LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 10/16/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-5222
  • Fax: 508-673-3182
Mailing address:
  • Phone: 401-519-1940
  • Fax: 401-519-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW02635
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: