Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1467848374 |
---|---|
Provider Name | Venette Jean JR. |
First Address | Lynn, MA 01901-1524 |
Second Address | Lynn, MA 01901-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 08/04/2015 |