Individual
JENNIFER A THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
160 OLD DERBY ST STE 110, HINGHAM, MA 02043-4010
(617) 688-1022
Mailing address
123 PHILLIPS ST, HANSON, MA 02341-1519
(617) 688-1022
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN231982
MA
Other
Enumeration date
03/18/2024
Last updated
08/31/2024
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