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NPI Code Detail

MEDICARE: MS. JENNIFER LYNN CONNOLLY M.S.

MEDICARE: MS. JENNIFER LYNN CONNOLLY M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst12044733MA
2103K00000XBehavior Analyst
3103K00000XBehavior Analyst1-20-44733MA

General Provider Information

NPI Number : 1023455185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER LYNN CONNOLLY M.S.
Provider Business Mailing Address
First Line : 29 MARBLEHEAD ST
Second Line :
City : NORTH READING
State : MA
Zip : 01864-1509
Country : US
Telephone Number : 781-572-0864
Fax Number :
Provider Business Practice Location Address
First Line : 132 ROBBS HILL RD
Second Line :
City : LUNENBURG
State : MA
Zip : 01462-2167
Country : US
Telephone Number : 781-572-0864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2013
Last Update Date : 12/21/2023

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