Healthcare Provider Details

I. General information

NPI: 1013142645
Provider Name (Legal Business Name): JENNIFER LYNNE FORTIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNNE BRENNAN LICSW

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 LOWER WESTFIELD RD
HOLYOKE MA
01104-9403
US

IV. Provider business mailing address

98 LOWER WESTFIELD RD
HOLYOKE MA
01040-9403
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-5201
  • Fax: 413-532-1846
Mailing address:
  • Phone: 413-533-5201
  • Fax: 413-532-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: