Provider Demographics
NPI:1295835965
Name:FENNELLY, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FENNELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ORCHARD VIEW DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3457
Mailing Address - Country:US
Mailing Address - Phone:603-421-0059
Mailing Address - Fax:
Practice Address - Street 1:13 ORCHARD VIEW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3457
Practice Address - Country:US
Practice Address - Phone:603-421-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE0602Medicare ID - Type Unspecified
R44660Medicare UPIN