Provider Demographics
NPI:1982941803
Name:DOANE, JENNIFER M (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DOANE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 1/2 MAIN ST
Mailing Address - Street 2:2E
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1696
Mailing Address - Country:US
Mailing Address - Phone:413-344-5398
Mailing Address - Fax:
Practice Address - Street 1:399 1/2 MAIN ST
Practice Address - Street 2:2E
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1696
Practice Address - Country:US
Practice Address - Phone:413-344-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10272631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical