Provider Demographics
NPI:1629395652
Name:HENNESSEY, ROBIN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MARIE
Last Name:HENNESSEY
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 1:12 WEQUETEQUOCK PSGE
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-2032
Mailing Address - Country:US
Mailing Address - Phone:860-857-3599
Mailing Address - Fax:860-495-5334
Practice Address - Street 1:616 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6221
Practice Address - Country:US
Practice Address - Phone:860-449-0200
Practice Address - Fax:860-449-1954
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0070581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical