Healthcare Provider Details

I. General information

NPI: 1407415862
Provider Name (Legal Business Name): JENIFFER ELIZABTH PIMENTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIDGING INDEPENDENT LIVING TOGETHER, INC. 215 LEXINGTON STREET
WOBURN MA
01801
US

IV. Provider business mailing address

BRIDGING INDEPENDENT LIVING TOGETHER, INC. 215 LEXINGTON STREET
WOBURN MA
01801
US

V. Phone/Fax

Practice location:
  • Phone: 617-999-5653
  • Fax:
Mailing address:
  • Phone: 617-999-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: