Provider Demographics
NPI:1528283793
Name:HENNESSY, VINCENT GEORGE (MA, LMHC, LPC)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:GEORGE
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 KISSIMMEE PL
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4617
Mailing Address - Country:US
Mailing Address - Phone:407-579-9279
Mailing Address - Fax:
Practice Address - Street 1:718 GARDEN PLZ
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4212
Practice Address - Country:US
Practice Address - Phone:407-894-8894
Practice Address - Fax:407-894-8893
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7624999-000Medicare ID - Type UnspecifiedMENTAL HEALTH ASSESSOR