Healthcare Provider Details

I. General information

NPI: 1003830811
Provider Name (Legal Business Name): JENNIFER MCCHORD FEENEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 CARRINGTON SKY DR
APOLLO BEACH FL
33572-1733
US

IV. Provider business mailing address

6610 CARRINGTON SKY DR
APOLLO BEACH FL
33572-1733
US

V. Phone/Fax

Practice location:
  • Phone: 774-240-7429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110550
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: