Provider Demographics
NPI:1003830811
Name:FEENEY, JENNIFER MCCHORD (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MCCHORD
Last Name:FEENEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 CARRINGTON SKY DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6610 CARRINGTON SKY DR
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1733
Practice Address - Country:US
Practice Address - Phone:774-240-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1105501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA263311OtherCOMPSYCH EAP
MA1858777Medicaid
MA561191000OtherBCBSMA MAGELLAN HEALTH
MAP08094OtherBCBSMA
MA263311OtherCOMPSYCH EAP