Provider Demographics
NPI:1265900245
Name:KENNY, JENA
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:ELIZABETH
Other - Last Name:MILARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:64 THOMPSON ST STE A101
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-5700
Mailing Address - Country:US
Mailing Address - Phone:203-691-1685
Mailing Address - Fax:203-891-6763
Practice Address - Street 1:64 THOMPSON ST STE A101
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-5700
Practice Address - Country:US
Practice Address - Phone:203-691-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT112311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker