=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932603545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANICE FINERTY LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6520 67TH ST
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53142-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-671-8552
-----------------------------------------------------
Fax | 414-435-9645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8464 S RIVER TERRACE DR
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53132-8222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-321-0825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | MS. JANICE KATHLEEN FINERTY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 847-321-0825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 8417-123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------