Provider Demographics
NPI:1609351162
Name:RONDEAU, JEANNINE (LICSW)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:RONDEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:
Other - Last Name:ROPNDEAU-KEEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2921
Mailing Address - Country:US
Mailing Address - Phone:508-655-2641
Mailing Address - Fax:
Practice Address - Street 1:4 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2921
Practice Address - Country:US
Practice Address - Phone:508-655-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015714-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2352MROtherNONE
MANJ2352MRMedicaid