Provider Demographics
NPI:1669911145
Name:HULL, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:7 CABOT RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3707
Mailing Address - Country:US
Mailing Address - Phone:508-358-3457
Mailing Address - Fax:
Practice Address - Street 1:154 E CENTRAL ST
Practice Address - Street 2:201A
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3644
Practice Address - Country:US
Practice Address - Phone:508-647-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical