Provider Demographics
NPI:1447428578
Name:JENKINS, ATHENA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:M
Last Name:JENKINS
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 1:6 LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2307
Mailing Address - Country:US
Mailing Address - Phone:203-494-3916
Mailing Address - Fax:203-281-5396
Practice Address - Street 1:713 GEORGE ST
Practice Address - Street 2:2ND FL STE# 2
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5207
Practice Address - Country:US
Practice Address - Phone:203-494-3916
Practice Address - Fax:203-281-5396
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical