Provider Demographics
NPI:1184108052
Name:SELLER, JENNIFER
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:397 GROVE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1223
Mailing Address - Country:US
Mailing Address - Phone:508-791-3677
Mailing Address - Fax:508-791-3655
Practice Address - Street 1:397 GROVE ST STE 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1223
Practice Address - Country:US
Practice Address - Phone:508-791-3677
Practice Address - Fax:508-791-3655
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor