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General NPI Number Information
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NPI Number | 1407624232
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Entity Type | Individual
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Provider Name | JENNI-LYNN FUOCO LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 472 GRANVILLE ST
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City | POULTNEY
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State | VT
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Zip | 05764-1109
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Country | US
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Telephone | 802-345-7599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | POULTNEY
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State | VT
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Zip | 05764-0189
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Country | US
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Telephone | 802-345-7599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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