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NPI Code Detail

MEDICARE: JENNIFER FONTAINE

MEDICARE: JENNIFER FONTAINE
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11303287OTHERMAMBHP
20000023532OTHERMABMC
31004745OTHERMAFALLON
4042611055OTHERMATAX ID
51004745OTHERMANHP
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
799618201OTHERMANETWORK HEALTH
8M18633OTHERMABCBS

General Provider Information

NPI Number : 1932408341
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER FONTAINE
Provider Business Mailing Address
First Line : 205 BURLINGTON RD
Second Line :
City : BEDFORD
State : MA
Zip : 01730-1406
Country : US
Telephone Number : 781-760-5089
Fax Number :
Provider Business Practice Location Address
First Line : 205 BURLINGTON RD
Second Line :
City : BEDFORD
State : MA
Zip : 01730-1406
Country : US
Telephone Number : 781-760-5089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2011
Last Update Date : 03/30/2021

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Directions to “ JENNIFER FONTAINE ” Practice Location

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