Provider Demographics
NPI:1912481615
Name:SELLERS, JENNA (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SELLERS
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 1:11 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9719
Mailing Address - Country:US
Mailing Address - Phone:413-427-4173
Mailing Address - Fax:
Practice Address - Street 1:247 CABOT ST STE 1
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3900
Practice Address - Country:US
Practice Address - Phone:413-532-2900
Practice Address - Fax:413-315-6338
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical