Provider Demographics
NPI:1134648181
Name:HANEY, JENNIFER JOY (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOY
Last Name:HANEY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3242
Mailing Address - Country:US
Mailing Address - Phone:814-362-4621
Mailing Address - Fax:814-362-1066
Practice Address - Street 1:723 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3242
Practice Address - Country:US
Practice Address - Phone:814-362-4621
Practice Address - Fax:814-362-1066
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW133953Medicaid