Provider Demographics
NPI:1104100015
Name:MAWSON, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DARISSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 PLEASANT ST
Mailing Address - Street 2:APT 6
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2428
Mailing Address - Country:US
Mailing Address - Phone:800-778-5560
Mailing Address - Fax:800-778-5560
Practice Address - Street 1:200 GRIFFIN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7145
Practice Address - Country:US
Practice Address - Phone:800-778-5560
Practice Address - Fax:800-778-5560
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22088103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst