Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003219148 |
---|---|
Provider Name | Jennifer Carolyn Freitas |
First Address | Worcester, MA 01605-3750 |
Second Address | Worcester, MA 01605-3750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2014 |
Last Update Date | 28/07/2017 |