Provider Demographics
NPI:1255117180
Name:FOOTE, JENNY (LSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:FOOTE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MILL ST STE 203
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1065
Mailing Address - Country:US
Mailing Address - Phone:570-218-8596
Mailing Address - Fax:
Practice Address - Street 1:620 MILL ST STE 203
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1065
Practice Address - Country:US
Practice Address - Phone:570-218-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138890104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker