Provider Demographics
NPI:1861701336
Name:FEEZOR, JENNIFER (LMSW-CC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:FEEZOR
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:VINALHAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04863-4119
Mailing Address - Country:US
Mailing Address - Phone:207-863-4341
Mailing Address - Fax:
Practice Address - Street 1:15 MEDICAL CENTER LOOP
Practice Address - Street 2:
Practice Address - City:VINALHAVEN
Practice Address - State:ME
Practice Address - Zip Code:04863-4119
Practice Address - Country:US
Practice Address - Phone:207-863-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker