Healthcare Provider Details

I. General information

NPI: 1730443623
Provider Name (Legal Business Name): JENNIFER A DURANTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 EVERGREEN ST STE 8A
KINGSTON MA
02364-1471
US

IV. Provider business mailing address

68 EVERGREEN ST STE 8A
KINGSTON MA
02364-1471
US

V. Phone/Fax

Practice location:
  • Phone: 774-454-4227
  • Fax:
Mailing address:
  • Phone: 774-454-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8014
License Number StateMA

VIII. Authorized Official

Name: MS. JENNIFER ANN DURANTE
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: MA, LMHC
Phone: 774-454-4227