Healthcare Provider Details

I. General information

NPI: 1871693929
Provider Name (Legal Business Name): JAMIE A REZENDES M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 COURT ST SUITE #102
PLYMOUTH MA
02360-7304
US

IV. Provider business mailing address

385 COURT ST SUITE #102
PLYMOUTH MA
02360-7304
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-3444
  • Fax: 508-746-3944
Mailing address:
  • Phone: 508-830-3444
  • Fax: 508-746-3944

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: