Provider Demographics
NPI:1316661218
Name:JENNINGS, CHARLES LEONARD (LMSW CASAC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEONARD
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:LMSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2679
Mailing Address - Country:US
Mailing Address - Phone:917-574-8796
Mailing Address - Fax:
Practice Address - Street 1:1603 CHESTER ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2679
Practice Address - Country:US
Practice Address - Phone:917-574-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081324104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty