Healthcare Provider Details

I. General information

NPI: 1427506443
Provider Name (Legal Business Name): CHRYSTAL JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/29/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MILLETT ST UNIT #1
GLOUCESTER MA
01930-2846
US

IV. Provider business mailing address

26 MILLETT ST UNIT #1
GLOUCESTER MA
01930-2846
US

V. Phone/Fax

Practice location:
  • Phone: 978-837-1888
  • Fax:
Mailing address:
  • Phone: 978-837-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: