Doctor Name: | MR. FRED MARK JANNEY |
NPI Number: | 1861795940 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMSW |
License Number: | 6801062755 |
Business Practice Address: | 11505 Weiman Dr Pinckney, MI - 481698016 |
Business Phone Number: | 7343305273 |
Business Fax Number: | 7348786575 |
Mailing Address: | 11505 Weiman Dr, PINCKNEY |
State: | MI |
Postal Code: | 481698016 |
Phone Number: | 7343305273 |
Fax Number: | 7348786575 |
NPI Enumeration Date: | 12/13/2010 |
NPI Last Update Date: | 12/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801062755 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |