Provider Demographics
NPI:1285186692
Name:FONTENOY, SERENA E (LMSW)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:E
Last Name:FONTENOY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 CINDERELLA CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 KANIS RD STE 2
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3794
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7955-M104100000X
AR7955-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker