Provider Demographics
NPI:1154547792
Name:SLATER, JENNIFER BROOKE (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BROOKE
Last Name:SLATER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BROOKE
Other - Last Name:OTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:88 FRONT ST
Mailing Address - Street 2:SUITE 23B
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1314
Mailing Address - Country:US
Mailing Address - Phone:339-526-1709
Mailing Address - Fax:
Practice Address - Street 1:88 FRONT ST
Practice Address - Street 2:SUITE 23B
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1314
Practice Address - Country:US
Practice Address - Phone:339-526-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health