Provider Demographics
NPI:1861677692
Name:JENNINGS, TIANE (LICSW)
Entity Type:Individual
Prefix:
First Name:TIANE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LEDGETREE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2109
Mailing Address - Country:US
Mailing Address - Phone:602-402-9596
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVEY PLACE
Practice Address - Street 2:BOX 1252 -- MOUNT SINAI HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-6843
Practice Address - Fax:212-534-2659
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720759571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical