Provider Demographics
NPI:1790473619
Name:FEENEY, JUSTIN RYAN (LICSW)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RYAN
Last Name:FEENEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SAMOSET AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3816
Mailing Address - Country:US
Mailing Address - Phone:774-955-2663
Mailing Address - Fax:
Practice Address - Street 1:40 SAMOSET AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3816
Practice Address - Country:US
Practice Address - Phone:774-955-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW036851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical