Provider Demographics
NPI:1871781484
Name:JENNINGS, WILLIAM STANLEY (EDD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STANLEY
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DUNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:01827-1320
Mailing Address - Country:US
Mailing Address - Phone:978-748-0067
Mailing Address - Fax:
Practice Address - Street 1:73 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:DUNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:01827-1320
Practice Address - Country:US
Practice Address - Phone:978-748-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical