MEDICARE: JENNIFER PUGH

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	1041C0700X	Clinical Social Worker	121251	MA

General Provider Information

NPI Number	:	1336572288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PUGH

Provider Business Mailing Address
First Line	:	163 HIGHLAND AVE # 1093
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3025
Country	:	US
Telephone Number	:	781-474-2258
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 HIGHLAND AVE # 1093
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3025
Country	:	US
Telephone Number	:	781-474-2258
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	04/02/2024

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