Provider Demographics
NPI:1508996992
Name:JENNY, EDWARD BRIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRIAN
Last Name:JENNY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W STREET RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1698
Mailing Address - Country:US
Mailing Address - Phone:610-444-6089
Mailing Address - Fax:610-925-1581
Practice Address - Street 1:127 W STREET RD
Practice Address - Street 2:SUITE 302
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1698
Practice Address - Country:US
Practice Address - Phone:610-444-6089
Practice Address - Fax:610-925-1581
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002152101YP2500X
PAPS016418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional