Provider Demographics
NPI:1063689891
Name:MCNEILLY, JENNIFER C (LICSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:C
Last Name:MCNEILLY
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5139
Mailing Address - Country:US
Mailing Address - Phone:770-757-6665
Mailing Address - Fax:
Practice Address - Street 1:41 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5139
Practice Address - Country:US
Practice Address - Phone:770-757-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039531041C0700X
MALICSW1159591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical