Provider Demographics
NPI:1144815234
Name:DEMPSEY, JACKIE
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MUNROE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1534
Mailing Address - Country:US
Mailing Address - Phone:239-281-5664
Mailing Address - Fax:
Practice Address - Street 1:1 MUNROE ST STE 2
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1534
Practice Address - Country:US
Practice Address - Phone:239-281-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician