Individual
DR. JENNIE KUCKERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 MILL ST, BELMONT, MA 02478-1064
(617) 855-2962
Mailing address
3020 CHILDRENS WAY, MC 5018, SAN DIEGO, CA 92123-4223
(630) 362-3645
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11367
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/12/2014
Last updated
10/28/2020
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