| Jillian Fenton, Licsw | |
|
11 King Charles Dr Suite A Portsmouth RI 02871-1364 | |
| (401) 683-2555 | |
| Not Available |
| Full Name | Jillian Fenton, Licsw |
|---|---|
| Speciality | Social Worker |
| Location | 11 King Charles Dr, Portsmouth, Rhode Island |
| Authorized Official Name and Position | Jillian Fenton (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4016832555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jillian Fenton, Licsw 11 King Charles Dr Suite A Portsmouth RI 02871-1364 Ph: (401) 683-2555 | Jillian Fenton, Licsw 11 King Charles Dr Suite A Portsmouth RI 02871-1364 Ph: (401) 683-2555 |
| NPI Number | 1992952402 |
|---|---|
| Provider Enumeration Date | 08/26/2008 |
| Last Update Date | 08/26/2008 |
| Medicare PECOS PAC ID | 9234206053 |
|---|---|
| Medicare Enrollment ID | O20080922000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992952402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 01636 (Rhode Island) | Primary |
| Provider Name | Jillian Fenton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083665921 PECOS PAC ID: 4183628993 Enrollment ID: I20060911000317 |
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