Provider Demographics
NPI:1861587354
Name:O'BRIEN-TRAFICANTE, JENNIFER ELIZABETH (MA, LCMHC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:O'BRIEN-TRAFICANTE
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SIMON ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-889-8648
Mailing Address - Fax:603-882-9666
Practice Address - Street 1:39 SIMON ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-889-8648
Practice Address - Fax:603-882-9666
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421029Medicaid