MEDICARE: JENNIFER A PONTILLO LMHC, LCMHC

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	101YM0800X	Mental Health Counselor	MHC00267	RI
2	101YM0800X	Mental Health Counselor	5448	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31117-1	OTHER		BLUE CROSS/SHIELD
2	12398397	OTHER		MULTIPLAN
3	413171	OTHER	RI	BLUE CHIP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	62-38609	OTHER	RI	UNITED
6	1021740	OTHER		NHP/BEACON-GROUP NUMBER
7	83125900	OTHER		MAGELLAN
8	1073750	OTHER	RI	NEIGHBORHOOD OF RI

General Provider Information

NPI Number	:	1760498604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A PONTILLO LMHC, LCMHC

Provider Business Mailing Address
First Line	:	163 HIGHLAND AVE # 1161
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3025
Country	:	US
Telephone Number	:	781-423-1856
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 HIGHLAND AVE # 1161
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3025
Country	:	US
Telephone Number	:	781-423-1856
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/30/2024

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