Provider Demographics
NPI:1568346690
Name:HENNEKA, DUSTIN STEPHEN (MSW)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:STEPHEN
Last Name:HENNEKA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FOUNTAIN OF YOUTH BLVD APT H
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4400
Mailing Address - Country:US
Mailing Address - Phone:904-392-7723
Mailing Address - Fax:
Practice Address - Street 1:29 FOUNTAIN OF YOUTH BLVD APT H
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4400
Practice Address - Country:US
Practice Address - Phone:904-392-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker