Provider Demographics
NPI:1740265321
Name:FERNEKEES-BOYLAN, JEANNE M (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:M
Last Name:FERNEKEES-BOYLAN
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:50 BROADWAY
Mailing Address - Street 2:LEAGUE FOR THE HARD OF HEARING 6TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1607
Mailing Address - Country:US
Mailing Address - Phone:917-305-7700
Mailing Address - Fax:917-305-7741
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:LEAGUE FOR THE HARD OF HEARING 6TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1607
Practice Address - Country:US
Practice Address - Phone:917-305-7700
Practice Address - Fax:917-305-7741
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY8031653-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N1M751Medicare ID - Type Unspecified