Provider Demographics
NPI:1871071266
Name:JEANNE DENEAULT, LICSW, LLC
Entity type:Organization
Organization Name:JEANNE DENEAULT, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-234-4265
Mailing Address - Street 1:709 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1616
Mailing Address - Country:US
Mailing Address - Phone:781-234-4265
Mailing Address - Fax:
Practice Address - Street 1:800 RESERVIOR PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-0237
Practice Address - Country:US
Practice Address - Phone:781-234-4265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty