Healthcare Provider Details

I. General information

NPI: 1033495072
Provider Name (Legal Business Name): MS. JENNY HERSHBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 DERBY ST SUITE 14
HINGHAM MA
02043-3728
US

IV. Provider business mailing address

62 DERBY ST SUITE 14
HINGHAM MA
02043-3728
US

V. Phone/Fax

Practice location:
  • Phone: 781-374-4100
  • Fax: 781-749-0809
Mailing address:
  • Phone: 781-374-4100
  • Fax: 781-749-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: