Jessica I Agenor
Individual provider Active NPI Mental Health Counselor · Peabody, MA
NPI 1093460370 · NPPES record last updated Feb 15, 2022
Key facts
- NPI
- 1093460370
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1R Newbury St Ste 401
Peabody, MA 01960-3816 - Phone
- (671) 804-2773
- NPI assigned
- Feb 15, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
1R Newbury St Ste 401
Peabody, MA 01960-3816
Mailing address
73 Porter St Apt 3
Malden, MA 02148-2872
Phone (781) 957-8713
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.