Healthcare Provider Details

I. General information

NPI: 1508214560
Provider Name (Legal Business Name): JENNY MARGO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 S MAIN ST STE 103
GREAT BARRINGTON MA
01230-2182
US

IV. Provider business mailing address

PO BOX 54
SOUTH EGREMONT MA
01258-0054
US

V. Phone/Fax

Practice location:
  • Phone: 413-300-6671
  • Fax:
Mailing address:
  • Phone: 413-300-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW121383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: