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NPI Code Detail

MEDICARE: JENNIFER PATRICIA FARETRA LISCW

MEDICARE: JENNIFER PATRICIA FARETRA LISCW
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
11041C0700XClinical Social Worker123369MA

General Provider Information

NPI Number : 1063164788
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER PATRICIA FARETRA LISCW
Provider Business Mailing Address
First Line : 11 MIDDLESEX AVE UNIT 8
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-2746
Country : US
Telephone Number : 978-587-7651
Fax Number :
Provider Business Practice Location Address
First Line : 11 MIDDLESEX AVE UNIT 8
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-2746
Country : US
Telephone Number : 978-587-7651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2022
Last Update Date : 06/21/2024

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Directions to “ JENNIFER PATRICIA FARETRA LISCW” Practice Location

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