Provider Demographics
NPI:1679048938
Name:FENNELLY, JOCELYNE MARIE (LICSW, CSAC)
Entity Type:Individual
Prefix:
First Name:JOCELYNE
Middle Name:MARIE
Last Name:FENNELLY
Suffix:
Gender:F
Credentials:LICSW, CSAC
Other - Prefix:
Other - First Name:JOCELYNE
Other - Middle Name:MARIE
Other - Last Name:BEAUBIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, CSAC
Mailing Address - Street 1:60 SCONTICUT NECK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1916
Mailing Address - Country:US
Mailing Address - Phone:508-999-0163
Mailing Address - Fax:
Practice Address - Street 1:60 SCONTICUT NECK RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-1916
Practice Address - Country:US
Practice Address - Phone:508-999-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical