Provider Demographics
NPI:1902478142
Name:ALMEIDA, JENNIFER AMANDA I (LADC 1)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:AMANDA
Last Name:ALMEIDA
Suffix:I
Gender:F
Credentials:LADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MILLER STILE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5423
Mailing Address - Country:US
Mailing Address - Phone:978-604-5773
Mailing Address - Fax:
Practice Address - Street 1:36 MILLER STILE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5423
Practice Address - Country:US
Practice Address - Phone:978-604-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19609101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)