Provider Demographics
NPI:1467673392
Name:FANEUFF, DENISE MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:FANEUFF
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 STERLING ST # 25A
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1200
Mailing Address - Country:US
Mailing Address - Phone:508-335-8364
Mailing Address - Fax:
Practice Address - Street 1:45 STERLING ST # 25A
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1200
Practice Address - Country:US
Practice Address - Phone:508-335-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11717976OtherCAQH