Healthcare Provider Details

I. General information

NPI: 1376195461
Provider Name (Legal Business Name): JENNIFER SHIRLEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CANAL ST STE 142P
SALEM MA
01970-4673
US

IV. Provider business mailing address

70 LOVETT ST APT 2
BEVERLY MA
01915-5273
US

V. Phone/Fax

Practice location:
  • Phone: 978-548-6288
  • Fax: 978-209-1802
Mailing address:
  • Phone: 203-837-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: