Healthcare Provider Details

I. General information

NPI: 1770051138
Provider Name (Legal Business Name): JOSEPH PATRICK HENNESSEY JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FEDERAL ST
GREENFIELD MA
01301-2546
US

IV. Provider business mailing address

92 COTTAGE ST
GREENFIELD MA
01301-1412
US

V. Phone/Fax

Practice location:
  • Phone: 413-726-8320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number198076
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN198076
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: