Provider Demographics
NPI:1083881213
Name:JENNINGS, EILEEN O'BRIEN (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:O'BRIEN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 EAST AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5020
Mailing Address - Country:US
Mailing Address - Phone:203-393-1766
Mailing Address - Fax:203-393-1705
Practice Address - Street 1:91 EAST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5020
Practice Address - Country:US
Practice Address - Phone:203-393-1766
Practice Address - Fax:203-393-1705
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT168662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry