Provider Demographics
NPI:1215030572
Name:SENIA, JACQUELYN D (LMSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:D
Last Name:SENIA
Suffix:
Gender:F
Credentials:LMSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 BUTTERNUT AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4585
Mailing Address - Country:US
Mailing Address - Phone:734-454-1119
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1074
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010215141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical