Provider Demographics
NPI:1316420466
Name:FENNESSY, NANCY SIMON (LICSW)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:SIMON
Last Name:FENNESSY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1998
Mailing Address - Country:US
Mailing Address - Phone:978-851-7321
Mailing Address - Fax:978-851-1026
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1998
Practice Address - Country:US
Practice Address - Phone:978-851-7321
Practice Address - Fax:978-851-1026
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical