Provider Demographics
NPI:1194356709
Name:LENNON, DENISE (EDD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E 4TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5056
Mailing Address - Country:US
Mailing Address - Phone:716-397-1727
Mailing Address - Fax:
Practice Address - Street 1:25 E 4TH ST STE 10
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5056
Practice Address - Country:US
Practice Address - Phone:716-397-1727
Practice Address - Fax:716-488-1830
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health