Doctor Name: | JENNIFER ANNE BOUTIN |
NPI Number: | 1033456595 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | |
Business Practice Address: | 90 New State Hwy Raynham, MA - 027675460 |
Business Phone Number: | 5088806868 |
Business Fax Number: | 5088806848 |
Mailing Address: | 90 New State Hwy, RAYNHAM |
State: | MA |
Postal Code: | 027675460 |
Phone Number: | 5088806868 |
Fax Number: | 5088806848 |
NPI Enumeration Date: | 01/03/2013 |
NPI Last Update Date: | 01/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |