Healthcare Provider Details

I. General information

NPI: 1700713385
Provider Name (Legal Business Name): MS. JENNA OLIVIA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CHURCH ST
LOWELL MA
01852-6113
US

IV. Provider business mailing address

23 BOW RD
BELMONT MA
02478-3503
US

V. Phone/Fax

Practice location:
  • Phone: 866-388-2242
  • Fax:
Mailing address:
  • Phone: 617-893-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: