MEDICARE: MRS. JENNIFER SELLER

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1184108052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SELLER

Provider Business Mailing Address
First Line	:	397 GROVE ST STE 2
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-1223
Country	:	US
Telephone Number	:	508-791-3677
Fax Number	:	508-791-3655

Provider Business Practice Location Address
First Line	:	397 GROVE ST STE 2
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-1223
Country	:	US
Telephone Number	:	508-791-3677
Fax Number	:	508-791-3655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/21/2022

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Directions to “ MRS. JENNIFER SELLER ” Practice Location

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