Provider Demographics
NPI:1225225923
Name:SANDWICK, JENNY EILEEN (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:EILEEN
Last Name:SANDWICK
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1340 CENTRE STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2444
Mailing Address - Country:US
Mailing Address - Phone:617-795-7350
Mailing Address - Fax:617-795-0953
Practice Address - Street 1:1340 CENTRE STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-2444
Practice Address - Country:US
Practice Address - Phone:617-795-7350
Practice Address - Fax:617-795-0953
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10251911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical