Healthcare Provider Details

I. General information

NPI: 1245143015
Provider Name (Legal Business Name): JERI LYNN BRODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST
HYANNIS MA
02601-3145
US

IV. Provider business mailing address

38 DWIGHT AVE
PLYMOUTH MA
02360-2167
US

V. Phone/Fax

Practice location:
  • Phone: 833-229-2683
  • Fax:
Mailing address:
  • Phone: 928-444-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: