Provider Demographics
NPI:1013142645
Name:FORTIN, JENNIFER LYNNE (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:FORTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:98 LOWER WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-9403
Mailing Address - Country:US
Mailing Address - Phone:413-533-5201
Mailing Address - Fax:413-532-1846
Practice Address - Street 1:98 LOWER WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01104-9403
Practice Address - Country:US
Practice Address - Phone:413-533-5201
Practice Address - Fax:413-532-1846
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical